Late Thrombectomy in Clinical Practice: Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry
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Late Thrombectomy in Clinical Practice: Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry. / Herzberg, Moriz; Scherling, Korbinian; Stahl, Robert; Tiedt, Steffen; Wollenweber, Frank A; Küpper, Clemens; Feil, Katharina; Forbrig, Robert; Patzig, Maximilian; Kellert, Lars; Kunz, Wolfgang G; Reidler, Paul; Zimmermann, Hanna; Liebig, Thomas; Dieterich, Marianne; Dorn, Franziska; GSR investigators.
In: CLIN NEURORADIOL, Vol. 31, No. 3, 09.2021, p. 799-810.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -