Safety of endovascular treatment beyond the 6-h time window in 205 patients.
Eur J Neurol
; 20(6): 865-71, 2013 Jun.
Article
em En
| MEDLINE
| ID: mdl-23293861
ABSTRACT
BACKGROUND AND PURPOSE:
Intra-arterial treatment (IAT) is effective when performed within 6â h of symptom onset in selected stroke patients ('Tâ <â 6H'). Its safety and efficacy is unclear when the patient has had symptoms for more than 6â h ('Tâ >â 6H') or for an unknown time (unclear-onset stroke, UOS), or woke up with a stroke (wake-up stroke, WUS). In this study we compared the safety of IAT in these four patient groups.METHODS:
Eight-hundred and fifty-nine patients treated with IAT were enrolled. The main outcome parameters were clinical outcome [excellent modified Rankin Scale (mRS) 0 or 1; or favorable mRS 0-2] or mortality 3â months after treatment. Further outcome parameters were the rates of vessel recanalization, and cerebral and systemic hemorrhage.RESULTS:
Six-hundred and fifty-four patients were treated before (Tâ <â 6H) and 205 after 6â h or an unknown time (128 Tâ >â 6H, 55 WUS and 22 UOS). NIHSS scores were higher in UOS patients than in Tâ <â 6H patients, vertebrobasilar occlusion was more common in Tâ >â 6H and UOS patients, and middle cerebral artery occlusions less common in Tâ >â 6H than in T < 6H patients. Other baseline characteristics were similar. There was no significant difference in clinical outcome and the rate of hemorrhage in multivariable regression analysis.CONCLUSIONS:
Clinical outcome of our four groups of patients was similar with no increase of hemorrhage rates in patients treated after awakening, after an unknown time or more than 6â h. Our preliminary data suggest that treatment of such patients may be performed safely. If confirmed in randomized trials, this would have major clinical implications.
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Base de dados:
MEDLINE
Assunto principal:
Ativador de Plasminogênio Tipo Uroquinase
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Terapia Trombolítica
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Acidente Vascular Cerebral
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Procedimentos Endovasculares
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur J Neurol
Assunto da revista:
NEUROLOGIA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Suíça