In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
Abstract:
Background: Following DAWN and DEFUSE 3, optimal imaging selection of large vessel ischemic stroke patients for thrombectomy 〉 6h is important. We hypothesized that perfusion mismatch used in EXTEND-IA and DEFUSE 3 would identify more patients eligible for thrombectomy than clinical-core mismatch used in DAWN. Methods: Prospectively collected data were analyzed for acute ischemic stroke patients aged 〉 18 with pre-treatment whole brain CT perfusion from 2012-2017 at a comprehensive stroke center. CTP was omitted 〉 6h in patients with extensive CT hypodensity. We compared the proportion of patients with anterior circulation large vessel occlusion (ICA, M1 and tandem occlusions) who fulfilled criteria for DAWN (clinical-core mismatch: age 〈 80 & NIHSS≥20 with 〈 51mL core, age 〈 80 & NIHSS10-19 with 〈 31mL core, age 〉 80 & NIHSS 〉 10 with 〈 21mL core), DEFUSE3 (mismatch ratio 〉 1.8, mismatch 〉 15mL, core 〈 70mL, age 〈 91, NIHSS 〉 5) and EXTEND-IA (mismatch ratio 〉 1.2, mismatch 〉 10mL, core 〈 70mL, no age or NIHSS limits). Pre-morbid function, alteplase eligibility and tandem occlusion trial exclusions were not applied to emulate clinical practice. Independent functional outcome was defined as 90 day mRS 0-2. Results: Of 982 ischemic stroke patients evaluated with pre-treatment CTP, 291 had large vessel occlusion. Within 6h of stroke onset, 175/231 (76%) patients met EXTEND-IA criteria compared to 153/231 (60%) DEFUSE3 and 96/231 (42%) DAWN, p 〈 0.0001 for all comparisons. Beyond 6h after onset, 39/58 (67%) met EXTEND-IA mismatch criteria compared to 33/58 (57%) DEFUSE 3 criteria and 26/58 (45%) DAWN criteria, p 〈 0.0001 for all comparisons. Overall 4 patients with clinical-core mismatch did not meet perfusion mismatch criteria. Patients eligible for DEFUSE3 but not DAWN achieved independence in 48% vs 40% in those eligible for both studies, OR 2.1 95%CI 0.9-5.0, p=0.09 in logistic regression adjusted for age and NIHSS. Similar findings applied to patients eligible for EXTEND-IA but not DAWN. Conclusions: Perfusion mismatch selection would lead to substantially more patients receiving thrombectomy than clinical-core mismatch. These patients were generally older with milder NIHSS, but had similar probability of independent outcomes.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.49.suppl_1.113
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2018
detail.hit.zdb_id:
1467823-8
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