Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and
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INTERVENTIONAL NEURORADIOLOGY
Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study Bence Gunda 1 & Ildikó Sipos 1 & Rita Stang 1 & Péter Böjti 1 & Levente Dobronyi 1 & Tímea Takács 1 & Tamás Berényi 2 & Balázs Futácsi 3 & Péter Barsi 4 & Gábor Rudas 4 & Balázs Kis 5 & István Szikora 5 & Dániel Bereczki 1,6 Received: 10 June 2020 / Accepted: 17 August 2020 # The Author(s) 2020
Abstract Purpose New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. Methods All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months. Results Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent. Conclusion Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window. Keywords Acute ischemic stroke . Thrombectomy . Extended time window . Caseload . Patient selection Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02531-8) contains supplementary material, which is available to authorized users. * Bence Gunda [email protected] 1
Department of Neurology, Semmelweis University, Budapest, Hungary
2
Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
3
Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
4
Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
5
National Institute of Clinical Neurosciences, Budapest, Hungary
6
MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
Introduction New AHA [1] and ESO [2] guidelines recommend endovascular treatment (EVT) of large vessel occlusion (LVO) strokes in an extended time window of 6 to 24 h in patients selected with advanced imaging, based on DAWN [3] a
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