Late Thrombectomy in Clinical Practice: Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry

TY - JOUR

T1 - Late Thrombectomy in Clinical Practice: Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry

AU - Herzberg, Moriz

AU - Scherling, Korbinian

AU - Stahl, Robert

AU - Tiedt, Steffen

AU - Wollenweber, Frank A

AU - Küpper, Clemens

AU - Feil, Katharina

AU - Forbrig, Robert

AU - Patzig, Maximilian

AU - Kellert, Lars

AU - Kunz, Wolfgang G

AU - Reidler, Paul

AU - Zimmermann, Hanna

AU - Liebig, Thomas

AU - Dieterich, Marianne

AU - Dorn, Franziska

AU - GSR investigators

N1 - © 2021. The Author(s).

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND AND PURPOSE: To provide real-world data on outcome and procedural factors of late thrombectomy patients.METHODS: We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2).RESULTS: Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6-24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes.CONCLUSION: In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6-24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.

AB - BACKGROUND AND PURPOSE: To provide real-world data on outcome and procedural factors of late thrombectomy patients.METHODS: We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2).RESULTS: Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6-24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes.CONCLUSION: In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6-24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.

KW - Brain Ischemia

KW - Humans

KW - Registries

KW - Retrospective Studies

KW - Stroke/diagnostic imaging

KW - Thrombectomy

KW - Treatment Outcome

U2 - 10.1007/s00062-021-01033-1

DO - 10.1007/s00062-021-01033-1

M3 - SCORING: Journal article

C2 - 34097080

VL - 31

SP - 799

EP - 810

JO - CLIN NEURORADIOL

JF - CLIN NEURORADIOL

SN - 1869-1439

IS - 3

ER -