Journal article
Imaging criteria across pivotal randomized controlled trials for late window thrombectomy patient selection.
- Menon BK Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
- Ospel JM Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
- McTaggart RA Warren Alpert School of Medicine & Brown University, Providence, Rhode Island, USA.
- Nogueira RG Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
- Demchuk AM Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
- Poppe A Department of Neurology/ Neurosciences, Universite de Montreal, Montreal, Quebec, Canada.
- Rempel JL Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.
- Zerna C Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- Joshi M Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
- Almekhlafi MA Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
- Field TS Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
- Dowlatshahi D Neurology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
- van Adel BA Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada.
- Sauvageau E Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida, USA.
- Tarpley J Vascular Neurology, Providence Saint John's Health Center and The Pacific Neuroscience Institute, Torrance, California, USA.
- Moreira T Neurology, Karolinska University Hospital, Stockholm, Sweden.
- Bang OY Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea.
- Heck D Radiology, Forsyth Medical Center, Winston Salem, North Carolina, USA.
- Psychogios MN Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
- Tymianski M NoNo Inc, Toronto, Ontario, Canada.
- Hill MD Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada.
- Goyal M Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada mgoyal2412@gmail.com.
- 2020-11-26
Published in:
- Journal of neurointerventional surgery. - 2020
English
BACKGROUND
The DAWN and DEFUSE-3 trials showed the benefit of endovascular treatment (EVT) in acute ischemic stroke patients presenting beyond 6 hours from last known well (LKW) and selected by perfusion imaging criteria. The ESCAPE NA1-trial selected patients based on non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS) and multiphase CT angiography (CTA) collateral status. This study compares baseline characteristics, workflow, and outcomes in the EVT arms of DAWN and DEFUSE-3 with late-window patients from the EVT-only arm of ESCAPE-NA1.
METHODS
Aggregate data on baseline characteristics, workflow, reperfusion quality, final infarct volume, and clinical outcomes (modified Rankin Score [mRS] at 90 days) in subjects enrolled in the DAWN and DEFUSE-3 EVT arms were compared with similar data from the ESCAPE-NA1 control arm (EVT-only arm) presenting beyond 6 hours from LKW using descriptive statistics.
RESULTS
Baseline characteristics among late-window patients in the ESCAPE NA1 trial were similar to those in the DAWN and DEFUSE-3 EVT arms. Median time from LKW-to-puncture in subjects enrolled in the ESCAPE NA1 trial was 9 hrs (IQR: 7.5-11 hours) when compared with DAWN (n=107; 12.8 hours, IQR: 10.6-16.7 hours) and DEFUSE-3 (n=92; 11.5 hours, IQR: 9.2-12.8 hours). Median post-treatment infarct-volume was largest in the ESCAPE NA1-patients (47 mL [IQR: 19-146] vs median 8 mL [IQR: 0-48] in the DAWN group and 35 mL [IQR: 18-82] in DEFUSE-3), while % mRS 0-2 at 90 days were similar across the three trials (ESCAPE NA1: 50/111 [45%], DAWN: 52/107 [49%], DEFUSE-3: 41/92 [45%]).
CONCLUSION
Patients enrolled beyond 6 hours from LKW in the ESCAPE-NA1 trial based on NCCT-ASPECTS and mCTA had similar clinical outcomes when compared with patients selected by perfusion imaging in the DAWN and DEFUSE-3 trials.
The DAWN and DEFUSE-3 trials showed the benefit of endovascular treatment (EVT) in acute ischemic stroke patients presenting beyond 6 hours from last known well (LKW) and selected by perfusion imaging criteria. The ESCAPE NA1-trial selected patients based on non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS) and multiphase CT angiography (CTA) collateral status. This study compares baseline characteristics, workflow, and outcomes in the EVT arms of DAWN and DEFUSE-3 with late-window patients from the EVT-only arm of ESCAPE-NA1.
METHODS
Aggregate data on baseline characteristics, workflow, reperfusion quality, final infarct volume, and clinical outcomes (modified Rankin Score [mRS] at 90 days) in subjects enrolled in the DAWN and DEFUSE-3 EVT arms were compared with similar data from the ESCAPE-NA1 control arm (EVT-only arm) presenting beyond 6 hours from LKW using descriptive statistics.
RESULTS
Baseline characteristics among late-window patients in the ESCAPE NA1 trial were similar to those in the DAWN and DEFUSE-3 EVT arms. Median time from LKW-to-puncture in subjects enrolled in the ESCAPE NA1 trial was 9 hrs (IQR: 7.5-11 hours) when compared with DAWN (n=107; 12.8 hours, IQR: 10.6-16.7 hours) and DEFUSE-3 (n=92; 11.5 hours, IQR: 9.2-12.8 hours). Median post-treatment infarct-volume was largest in the ESCAPE NA1-patients (47 mL [IQR: 19-146] vs median 8 mL [IQR: 0-48] in the DAWN group and 35 mL [IQR: 18-82] in DEFUSE-3), while % mRS 0-2 at 90 days were similar across the three trials (ESCAPE NA1: 50/111 [45%], DAWN: 52/107 [49%], DEFUSE-3: 41/92 [45%]).
CONCLUSION
Patients enrolled beyond 6 hours from LKW in the ESCAPE-NA1 trial based on NCCT-ASPECTS and mCTA had similar clinical outcomes when compared with patients selected by perfusion imaging in the DAWN and DEFUSE-3 trials.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1136/neurintsurg-2020-016902
- PMID 33239306
- Persistent URL
- https://sonar.ch/global/documents/93772
Export to…
Statistics
Document views: 76
File downloads: