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

Document Type

Article

Publication Title

International journal of stroke : official journal of the International Stroke Society

Abstract

BACKGROUND: The effect of time from stroke onset to thrombectomy in the extended time window remains poorly characterized.

AIM: We aimed to analyze the relationship between time to treatment and clinical outcomes in the early versus extended time windows.

METHODS: Proximal anterior circulation occlusion patients from a multicentric prospective registry were categorized into early (≤6 h) or extended (>6-24 h) treatment window. Patients with baseline National Institutes of Health Stroke Scale (NIHSS) ≥ 10 and intracranial internal carotid artery or middle cerebral artery-M1-segment occlusion and pre-morbid modified Rankin scale (mRS) 0-1 ("DAWN-like" cohort) served as the population for the primary analysis. The relationship between time to treatment and 90-day mRS, analyzed in ordinal (mRS shift) and dichotomized (good outcome, mRS 0-2) fashion, was compared within and across the extended and early windows.

RESULTS: A total of 1603 out of 2008 patients qualified. Despite longer time to treatment (9[7-13.9] vs. 3.4[2.5-4.3] h,

CONCLUSIONS: The impact of time to thrombectomy on outcomes appears to be time dependent with a steep influence in the early followed by a less significant plateau in the extended window. However, every effort should be made to shorten treatment times regardless of ischemia duration.

First Page

331

Last Page

340

DOI

10.1177/17474930211006304

Publication Date

3-1-2022

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