Format

Send to

Choose Destination
Eur J Neurol. 2019 Sep 19. doi: 10.1111/ene.14083. [Epub ahead of print]

Association between time to treatment and functional outcomes according to DWI-ASPECTS in endovascular stroke therapy.

Author information

1
Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
2
Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
3
Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
4
Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
5
Eulji University Hospital, Eulji University, Daejeon, Korea.
6
Dong-A University Hospital, Busan, Korea.
7
Seoul Medical Center, Seoul, Korea.
8
Soonchunhyang University Hospital, Seoul, Korea.
9
Yeungnam University Hospital, Daegu, Korea.
10
Ilsan Paik Hospital, Inje University, Goyang, Korea.
11
Hallym University Sacred Heart Hospital, Anyang, Korea.
12
Dongguk University Ilsan Hospital, Goyang, Korea.
13
Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
14
Ulsan University College of Medicine, Ulsan, Korea.
15
Chungbuk National University Hospital, Cheongju, Korea.
16
Keimyung University Dongsan Medical Center, Daegu, Korea.
17
Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
18
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
19
Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, at the University of California Los Angeles, Los Angeles.

Abstract

BACKGROUND:

The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline DWI-MRI and whether ischaemic core size affects this rate remain to be investigated.

METHODS:

This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into 3 groups: small (DWI-ASPECTS 8-10), moderate (5-7), and large (<5) cores. The main outcome was a good outcome at 90 days (mRS 0-2). The interaction between onset-to-groin puncture (OTP) time and DWI-ASPECTS categories regarding functional outcomes was investigated.

RESULTS:

Ultimately, 985 patients (age, 69±11 yr; male, 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (Pinteraction =0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days among patients with large cores, although no associations were observed among patients with small-moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (Pnonlinearity =0.15).

CONCLUSIONS:

Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted. This article is protected by copyright. All rights reserved.

KEYWORDS:

DWI-ASPECTS; acute ischaemic stroke; endovascular therapy; time to treatment

PMID:
31535427
DOI:
10.1111/ene.14083

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center