Safety and Efficacy of Thrombectomy in Vietnamese Stroke Patients Selected through Perfusion Imaging with an Onset Time between 6 and 24 Hours.

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  • Additional Information
    • Source:
      Publisher: Karger Country of Publication: Switzerland NLM ID: 101577885 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1664-5456 (Electronic) Linking ISSN: 16645456 NLM ISO Abbreviation: Cerebrovasc Dis Extra Subsets: MEDLINE
    • Publication Information:
      Original Publication: Basel : Karger, 2011-
    • Subject Terms:
      Thrombectomy*/adverse effects ; Thrombectomy*/mortality ; Perfusion Imaging* ; Time-to-Treatment* ; Ischemic Stroke*/therapy ; Ischemic Stroke*/mortality ; Ischemic Stroke*/diagnostic imaging ; Ischemic Stroke*/physiopathology ; Functional Status* ; Recovery of Function* ; Cerebrovascular Circulation* ; Predictive Value of Tests* ; Disability Evaluation*; Humans ; Male ; Aged ; Female ; Prospective Studies ; Vietnam ; Time Factors ; Treatment Outcome ; Middle Aged ; Risk Factors ; Patient Selection ; Endovascular Procedures/adverse effects ; Endovascular Procedures/mortality ; Risk Assessment ; Aged, 80 and over ; Intracranial Hemorrhages/mortality ; Intracranial Hemorrhages/etiology ; Collateral Circulation ; Southeast Asian People
    • Abstract:
      Introduction: Recent trials have demonstrated the remarkable benefit of endovascular treatment (EVT) up to 24 h in patients with large vessel occlusion (LVO) and target mismatch profiles; however, benefits of late-window EVT in Vietnamese population remain poorly understood. This study aims to evaluate the real-world outcomes of EVT in acute ischemic stroke (AIS) patients selected using perfusion imaging within the 6-24-h window.
      Methods: This is a prospective study of consecutive patients with anterior circulation LVO stroke who underwent EVT within 6-24 h after last known well between August 2022 and March 2024. Patients were selected based on the DAWN/DEFUSE-3 criteria (Perfusion-RAPID, iSchemaView). The primary outcome was the proportion of patients with functional independence at 90 days (modified Rankin Scale score of 0-2). The secondary outcomes were successful reperfusion defined by thrombolysis in cerebral infarction (TICI) ≥2b on the final procedure and subgroup analysis between good (hypoperfusion intensity ratio [HIR] <0.4) and poor collaterals (HIR ≥0.4) groups. Safety outcomes were mortality rate and symptomatic intracranial hemorrhage (sICH).
      Results: Of 122 enrolled patients, 68% met inclusion criteria of DEFUSE-3 trial, 61% met DAWN trial criteria. Mean age was 66 years, median baseline NIHSS was 13, median time from stroke onset to hospital arrival was 12.55 h (9.50-16.48), and median infarct volume was 11.5 mL. The rate of functional independence at 90 days was 45.9%. Successful reperfusion (TICI score of ≥2b) was achieved by 83.6% of cases. The 90-day mortality rate was 10.7%; sICH was reported in 8 patients (6.6%). Patients with good collaterals had better functional outcome.
      Conclusions: This real-world observational study suggests that late-window EVT may be safe and effective in eligible Vietnamese patients selected based on perfusion imaging, thus supporting its practical use in this patient population. HIR is a robust indicator of collateral status and could made it a valuable addition to stroke imaging workup in clinical setting.
      (© 2024 The Author(s). Published by S. Karger AG, Basel.)
    • References:
      Stroke. 2018 Sep;49(9):2102-2107. (PMID: 30354992)
      N Engl J Med. 2018 Feb 22;378(8):708-718. (PMID: 29364767)
      Stroke. 2015 May;46(5):1239-44. (PMID: 25791716)
      JAMA Neurol. 2016 Feb;73(2):190-6. (PMID: 26716735)
      Eur J Neurol. 2020 May;27(5):864-870. (PMID: 32068938)
      Stroke. 2011 Mar;42(3):693-9. (PMID: 21233472)
      Front Neurol. 2017 Nov 30;8:651. (PMID: 29250029)
      Stroke. 2019 Dec;50(12):e344-e418. (PMID: 31662037)
      Cerebrovasc Dis Extra. 2023;13(1):69-74. (PMID: 37263248)
      Acta Neurol Scand. 2020 Sep;142(3):191-199. (PMID: 32342996)
      Neurology. 2021 Jan 12;96(2):e161-e170. (PMID: 33262233)
      Stroke. 2019 Apr;50(4):917-922. (PMID: 30841821)
      Lancet. 2007 Jan 27;369(9558):275-82. (PMID: 17258667)
      Eur J Neurol. 2017 Jun;24(6):762-767. (PMID: 28432712)
      J Neurol Neurosurg Psychiatry. 2008 Jun;79(6):625-9. (PMID: 18077482)
      N Engl J Med. 2018 Jan 4;378(1):11-21. (PMID: 29129157)
      Stroke. 2011 Aug;42(8):2235-9. (PMID: 21737798)
      J Neurointerv Surg. 2019 Mar;11(3):241-245. (PMID: 30415226)
      Stroke. 2019 Mar;50(3):754-757. (PMID: 30735466)
      Stroke. 2014 Apr;45(4):1018-23. (PMID: 24595591)
      Stroke. 2016 Mar;47(3):768-76. (PMID: 26903582)
      Lancet. 2016 Apr 23;387(10029):1723-31. (PMID: 26898852)
    • Contributed Indexing:
      Keywords: 6–24 h; Acute ischemic stroke; Collaterals; Endovascular treatment of acute stroke; Hypoperfusion intensity ratio; Late window; Perfusion imaging
    • Publication Date:
      Date Created: 20241119 Date Completed: 20241223 Latest Revision: 20250104
    • Publication Date:
      20250104
    • Accession Number:
      PMC11666263
    • Accession Number:
      10.1159/000542653
    • Accession Number:
      39561739