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Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion

医学 溶栓 冲程(发动机) 改良兰金量表 磁共振成像 灌注扫描 大脑中动脉 颈内动脉 脑出血 外科 内科学 放射科 心脏病学 缺血 灌注 心肌梗塞 缺血性中风 蛛网膜下腔出血 机械工程 工程类
作者
Fatih Seker,Muhammad M. Qureshi,Markus A Möhlenbruch,Raul G Nogueira,Mohamad Abdalkader,Marc Ribó,François Caparros,Diogo C Haussen,Mahmoud H Mohammaden,Sunil A Sheth,Santiago Ortega-Gutierrez,James E. Siegler,Syed F. Zaidi,Marta Olivé-Gadea,Hilde Hénon,Alicia C. Castonguay,Stefania Nannoni,Johannes Kaesmacher,Ajit S. Puri,Mudassir Farooqui,Sergio Salazar-Marioni,Anna Luisa Kühn,Nicole Kiley,Behzad Farzin,William Boisseau,Hesham Masoud,Carlos F. Lopez,Ameena Rana,Samer A Abdul Kareem,Anvitha Sathya,Piers Klein,Mohammad W. Kassem,Charlotte Cordonnier,Jan Gralla,Ulrich Fischer,Patrik Michel,Davide Strambo,Tudor G Jovin,Jean Raymond,Osama O. Zaidat,Peter A. Ringleb,Thanh N. Nguyen,Simon Nagel
出处
期刊:Stroke [Ovid Technologies (Wolters Kluwer)]
卷期号:53 (12): 3594-3604 被引量:12
标识
DOI:10.1161/strokeaha.122.039476
摘要

Reperfusion without functional independence (RFI) is an undesired outcome following thrombectomy in acute ischemic stroke. The primary objective was to evaluate, in patients presenting with proximal anterior circulation occlusion stroke in the extended time window, whether selection with computed tomography (CT) perfusion or magnetic resonance imaging is associated with RFI, mortality, or symptomatic intracranial hemorrhage (sICH) compared with noncontrast CT selected patients.The CLEAR study (CT for Late Endovascular Reperfusion) was a multicenter, retrospective cohort study of stroke patients undergoing thrombectomy in the extended time window. Inclusion criteria for this analysis were baseline National Institutes of Health Stroke Scale score ≥6, internal carotid artery, M1 or M2 segment occlusion, prestroke modified Rankin Scale score of 0 to 2, time-last-seen-well to treatment 6 to 24 hours, and successful reperfusion (modified Thrombolysis in Cerebral Infarction 2c-3).Of 2304 patients in the CLEAR study, 715 patients met inclusion criteria. Of these, 364 patients (50.9%) showed RFI (ie, mRS score of 3-6 at 90 days despite successful reperfusion), 37 patients (5.2%) suffered sICH, and 127 patients (17.8%) died within 90 days. Neither imaging selection modality for thrombectomy candidacy (noncontrast CT versus CT perfusion versus magnetic resonance imaging) was associated with RFI, sICH, or mortality. Older age, higher baseline National Institutes of Health Stroke Scale, higher prestroke disability, transfer to a comprehensive stroke center, and a longer interval to puncture were associated with RFI. The presence of M2 occlusion and higher baseline Alberta Stroke Program Early CT Score were inversely associated with RFI. Hypertension was associated with sICH.RFI is a frequent phenomenon in the extended time window. Neither magnetic resonance imaging nor CT perfusion selection for mechanical thrombectomy was associated with RFI, sICH, and mortality compared to noncontrast CT selection alone.URL: https://www.gov; Unique identifier: NCT04096248.
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