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Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study
PURPOSE: New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. METHODS: All co...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966226/ https://www.ncbi.nlm.nih.gov/pubmed/32935174 http://dx.doi.org/10.1007/s00234-020-02531-8 |
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author | Gunda, Bence Sipos, Ildikó Stang, Rita Böjti, Péter Dobronyi, Levente Takács, Tímea Berényi, Tamás Futácsi, Balázs Barsi, Péter Rudas, Gábor Kis, Balázs Szikora, István Bereczki, Dániel |
author_facet | Gunda, Bence Sipos, Ildikó Stang, Rita Böjti, Péter Dobronyi, Levente Takács, Tímea Berényi, Tamás Futácsi, Balázs Barsi, Péter Rudas, Gábor Kis, Balázs Szikora, István Bereczki, Dániel |
author_sort | Gunda, Bence |
collection | PubMed |
description | PURPOSE: New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. METHODS: All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months. RESULTS: Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent. CONCLUSION: Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00234-020-02531-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7966226 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-79662262021-04-01 Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study Gunda, Bence Sipos, Ildikó Stang, Rita Böjti, Péter Dobronyi, Levente Takács, Tímea Berényi, Tamás Futácsi, Balázs Barsi, Péter Rudas, Gábor Kis, Balázs Szikora, István Bereczki, Dániel Neuroradiology Interventional Neuroradiology PURPOSE: New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. METHODS: All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months. RESULTS: Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent. CONCLUSION: Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00234-020-02531-8) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-09-15 2021 /pmc/articles/PMC7966226/ /pubmed/32935174 http://dx.doi.org/10.1007/s00234-020-02531-8 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Interventional Neuroradiology Gunda, Bence Sipos, Ildikó Stang, Rita Böjti, Péter Dobronyi, Levente Takács, Tímea Berényi, Tamás Futácsi, Balázs Barsi, Péter Rudas, Gábor Kis, Balázs Szikora, István Bereczki, Dániel Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title | Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title_full | Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title_fullStr | Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title_full_unstemmed | Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title_short | Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
title_sort | comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study |
topic | Interventional Neuroradiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966226/ https://www.ncbi.nlm.nih.gov/pubmed/32935174 http://dx.doi.org/10.1007/s00234-020-02531-8 |
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