In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Abstract:
Background: Recent clinical trials have proven efficacy of endovascular therapy (EVT) for anterior circulation large vessel occlusion (acLVO). The DAWN and DEFUSE 3 trials have selected patients for EVT beyond 6h from symptom onset. We sought to determine how many patients of our center would qualify to apply advanced DAWN or DEFUSE 3 imaging criteria based on clinical symptoms and imaging with non-contrast CT (NCCT) and CT angiography (CTA). Methods: We prospectively registered consecutive ischemic stroke patients who were screened for EVT eligibility between 01/2016 and 12/2017. Of these patients, we identified those who fulfilled DAWN (age ≥18years, pre-morbid mRS score ≤1 , NIHSS score ≥10, onset-to-CT time 6-24 hours) and DEFUSE 3 (age 18- 90 years, pre-morbid mRS score ≤2, NIHSS score ≥6, onset-to-CT time 6-16 hours) inclusion criteria, respectively. Of these, we identified patients with acLVO on CTA and early ischemic changes in ≤1/3 of the middle cerebral artery territory (DAWN) or NCCT-ASPECTS 〉 6 (DEFUSE-3), respectively. Results: Among 1011 patients who presented during the study period, 362 patients (36%) had an onset-to-CT time between 6-24 hours and 244 patients (24%) between 6-16 hours. Among the 6-24 hours cohort, 62 patients had an NIHSS score ≥10. Of these, 30 patients had acLVO of whom 13 patients had early ischemic changes ≤1/3 of the MCA territory on NCCT. Among the 6-16 hours cohort, 69 patients had an NIHSS score ≥6. Of these, 33 patients had acLVO of whom 18 patients had a NCCT-ASPECTS 〉 6. Despite early ischemic changes in ≤1/3 of the MCA territory in 320 patients presenting 〉 6 hours from symptom onset, no acute vascular imaging was performed in 108 patients. Overall, 19 patients (2% of the complete cohort) fulfilled clinical and imaging criteria utilized in DAWN or DEFUSE-3 trials. Of these, only 10 patients (1% of the complete cohort) received additional perfusion CT of whom 7 patients eventually underwent EVT. Conclusions: Only a minority (2%) of patients in our cohort would have qualified to apply advance imaging criteria based on DAWN or DEFUSE-3 trials for EVT beyond 6 hours from stroke onset. However, the positive results of these trials may have an impact on future assessment of EVT eligibility in patients presenting at a later time window.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.WP19
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
1467823-8
