The golden 35â
min of stroke intervention with ADAPT: effect of thrombectomy procedural time in acute ischemic stroke on outcome.
J Neurointerv Surg
; 10(3): 213-220, 2018 Mar.
Article
em En
| MEDLINE
| ID: mdl-28465405
ABSTRACT
INTRODUCTION:
In acute ischemic stroke (AIS), extending mechanical thrombectomy procedural times beyond 60â min has previously been associated with an increased complication rate and poorer outcomes.OBJECTIVE:
After improvements in thrombectomy methods, to reassess whether this relationship holds true with a more contemporary thrombectomyapproach:
a direct aspiration first pass technique (ADAPT).METHODS:
We retrospectively studied a database of patients with AIS who underwent ADAPT thrombectomy for large vessel occlusions. Patients were dichotomized into two groups 'early recan', in which recanalization (recan) was achieved in ≤35â min, and 'late recan', in which procedures extended beyond 35â min.RESULTS:
197 patients (47.7% women, mean age 66.3â years) were identified. We determined that after 35â min, a poor outcome was more likely than a good (modified Rankin Scale (mRS) score 0-2) outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score was similar between 'early recan' (n=122) (14.7±6.9) and 'late recan' patients (n=75) (15.9±7.2). Among 'early recan' patients, recanalization was achieved in 17.8±8.8â min compared with 70±39.8â min in 'late recan' patients. The likelihood of achieving a good outcome was higher in the 'early recan' group (65.2%) than in the 'late recan' group (38.2%; p<0.001). Patients in the 'late recan' group had a higher likelihood of postprocedural hemorrhage, specifically parenchymal hematoma type 2, than those in the 'early recan' group. Logistic regression analysis showed that baseline NIHSS, recanalization time, and atrial fibrillation had a significant impact on 90-day outcomes.CONCLUSIONS:
Our findings suggest that extending ADAPT thrombectomy procedure times beyond 35â min increases the likelihood of complications such as intracerebral hemorrhage while reducing the likelihood of a good outcome.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Isquemia Encefálica
/
Trombectomia
/
Acidente Vascular Cerebral
/
Tempo para o Tratamento
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article