What question did this study set out to answer?

To determine how the interval from stroke onset to endovascular thrombectomy influences clinical outcomes when performed in the early (≤6 hours) versus extended (>6–24 hours) time windows.

March 16, 2021International Journal of StrokeOpen Access

Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms

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Authors

RNRaul G. NogueiraEmory University TJTudor G. JovinBoston University DHDiogo C HaussenGrady Memorial Hospital

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Implication

Prospective registry study reveals time to thrombectomy dictates recovery in early but not extended windows, indicating persistent treatment benefits despite delays.

Key Points

To determine how the interval from stroke onset to endovascular thrombectomy influences clinical outcomes when performed in the early (≤6 hours) versus extended (>6–24 hours) time windows.
Analyzed 1,603 patients with proximal anterior circulation occlusions from a multicentric prospective registry, identifying a primary DAWN-like cohort (NIHSS ≥ 10, ICA or MCA-M1 occlusion, baseline mRS 0–1; n = 709 early window, n = 257 extended window).
Evaluated 90-day modified Rankin Scale (mRS) outcomes using ordinal shift and dichotomized good functional outcome (mRS 0–2) models adjusted for confounders.
Extended-window patients had significantly longer median treatment times (9.0 vs. 3.4 hours, p < 0.001) but showed similar rates of symptomatic intracranial hemorrhage (0.8% vs. 1.7%, p = 0.293) and 90-day mortality (10.5% vs. 9.6%, p = 0.714), with marginally lower good outcome rates (50.4% vs. 57.6%, p = 0.047) compared to early-window patients.
Treatment delay was associated with worse 90-day disability in the early window (mRS shift aOR: 0.75, 95% CI [0.66–0.86], p < 0.001; mRS 0–2 aOR: 0.73, 95% CI [0.62–0.86], p < 0.001) but was not significantly associated with outcomes in the extended window (mRS shift aOR: 0.96, 95% CI [0.90–1.02], p = 0.15; mRS 0–2 aOR: 0.97, 95% CI [0.90–1.04], p = 0.41).
Early-window patients achieved significantly lower overall 90-day functional disability compared to extended-window patients (ordinal mRS shift aOR: 1.533, 95% CI [1.138–2.065], p = 0.005).

Cite This Study

Nogueira et al. (2021) studied this question.

synapsesocial.com/papers/6a894f86a14d41d02f431e23 https://doi.org/10.1177/17474930211006304

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Implication

Prospective registry study reveals time to thrombectomy dictates recovery in early but not extended windows, indicating persistent treatment benefits despite delays.

Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms

Discussion

Member takes

Implication

Key Points

Cite This Study

Influence of time to endovascular stroke treatment on outcomes in the early versus extended window paradigms

Discussion

Member takes

Implication

Key Points

Cite This Study

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