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Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction

Standard

Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction. / Broocks, Gabriel; Hanning, Uta; Bechstein, Matthias; Elsayed, Sarah; Faizy, Tobias D; Brekenfeld, Caspar; Flottmann, Fabian; Kniep, Helge; Deb-Chatterji, Milani; Schön, Gerhard; Thomalla, Götz; Kemmling, André; Fiehler, Jens; Meyer, Lukas; German Stroke Registry – Endovascular Treatment (GSR – ET).

In: JAMA NETW OPEN, Vol. 5, No. 10, e2235733, 03.10.2022.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Broocks, G, Hanning, U, Bechstein, M, Elsayed, S, Faizy, TD, Brekenfeld, C, Flottmann, F, Kniep, H, Deb-Chatterji, M, Schön, G, Thomalla, G, Kemmling, A, Fiehler, J, Meyer, L & German Stroke Registry – Endovascular Treatment (GSR – ET) 2022, 'Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction', JAMA NETW OPEN, vol. 5, no. 10, e2235733. https://doi.org/10.1001/jamanetworkopen.2022.35733

APA

Broocks, G., Hanning, U., Bechstein, M., Elsayed, S., Faizy, T. D., Brekenfeld, C., Flottmann, F., Kniep, H., Deb-Chatterji, M., Schön, G., Thomalla, G., Kemmling, A., Fiehler, J., Meyer, L., & German Stroke Registry – Endovascular Treatment (GSR – ET) (2022). Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction. JAMA NETW OPEN, 5(10), [e2235733]. https://doi.org/10.1001/jamanetworkopen.2022.35733

Vancouver

Broocks G, Hanning U, Bechstein M, Elsayed S, Faizy TD, Brekenfeld C et al. Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction. JAMA NETW OPEN. 2022 Oct 3;5(10). e2235733. https://doi.org/10.1001/jamanetworkopen.2022.35733

Bibtex

@article{5000e80ddf1948e9b81f5e7608bbd0b2,
title = "Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction",
abstract = "Importance: Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Objective: To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Design, Setting, and Participants: This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019.Main Outcomes and Measures: The primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis.Intervention: Endovascular treatment.Results: Of 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P < .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P < .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285).Conclusions and Relevance: In this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.",
keywords = "Aged, Brain Ischemia/surgery, Cerebral Infarction, Cohort Studies, Endovascular Procedures/methods, Humans, Ischemic Stroke/surgery, Male, Retrospective Studies, Stroke/surgery, Thrombectomy/methods, Treatment Outcome",
author = "Gabriel Broocks and Uta Hanning and Matthias Bechstein and Sarah Elsayed and Faizy, {Tobias D} and Caspar Brekenfeld and Fabian Flottmann and Helge Kniep and Milani Deb-Chatterji and Gerhard Sch{\"o}n and G{\"o}tz Thomalla and Andr{\'e} Kemmling and Jens Fiehler and Lukas Meyer and {German Stroke Registry – Endovascular Treatment (GSR – ET)}",
year = "2022",
month = oct,
day = "3",
doi = "10.1001/jamanetworkopen.2022.35733",
language = "English",
volume = "5",
journal = "JAMA NETW OPEN",
issn = "2574-3805",
publisher = "American Medical Association",
number = "10",

}

RIS

TY - JOUR

T1 - Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction

AU - Broocks, Gabriel

AU - Hanning, Uta

AU - Bechstein, Matthias

AU - Elsayed, Sarah

AU - Faizy, Tobias D

AU - Brekenfeld, Caspar

AU - Flottmann, Fabian

AU - Kniep, Helge

AU - Deb-Chatterji, Milani

AU - Schön, Gerhard

AU - Thomalla, Götz

AU - Kemmling, André

AU - Fiehler, Jens

AU - Meyer, Lukas

AU - German Stroke Registry – Endovascular Treatment (GSR – ET)

PY - 2022/10/3

Y1 - 2022/10/3

N2 - Importance: Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Objective: To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Design, Setting, and Participants: This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019.Main Outcomes and Measures: The primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis.Intervention: Endovascular treatment.Results: Of 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P < .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P < .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285).Conclusions and Relevance: In this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.

AB - Importance: Only limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Objective: To assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Design, Setting, and Participants: This retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry-Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019.Main Outcomes and Measures: The primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis.Intervention: Endovascular treatment.Results: Of 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P < .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P < .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285).Conclusions and Relevance: In this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.

KW - Aged

KW - Brain Ischemia/surgery

KW - Cerebral Infarction

KW - Cohort Studies

KW - Endovascular Procedures/methods

KW - Humans

KW - Ischemic Stroke/surgery

KW - Male

KW - Retrospective Studies

KW - Stroke/surgery

KW - Thrombectomy/methods

KW - Treatment Outcome

U2 - 10.1001/jamanetworkopen.2022.35733

DO - 10.1001/jamanetworkopen.2022.35733

M3 - SCORING: Journal article

C2 - 36239941

VL - 5

JO - JAMA NETW OPEN

JF - JAMA NETW OPEN

SN - 2574-3805

IS - 10

M1 - e2235733

ER -