Abstract 78: Time to Endovascular Treatment and Outcomes in the DAWN Trial

Nogueira, Raul G; Haussen, Diogo C; Jadhav, Ashutosh; Liebeskind, David S; Budzik, Ronald F; Bonafé, Alain; Bhuva, Parita; Yavagal, Dileep R.; Hanel, Ricardó A.; Ribó, Marc; Cognard, Christophe; Sila, Cathy A.; Hassan, Ameer E; Frankel, Michael; Smith, Wade S.; Saver, Jeffrey L.; Jovin, Tudor G

doi:10.1161/str.49.suppl_1.78

Cited by 28 publications

(47 citation statements)

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“…[ 13 ] While clinical benefit was shown out to 24 h, post hoc analysis has shown that a decay in efficacy is still seen with each hour of delay continuing to negatively affect functional independence. The absolute risk difference for mRS 0–2 at 8 h was 24.4% versus 35.5% at 24 h.[ 14 ] DEFUSE-3 enrolled 92 patients from 38 centers in the thrombectomy arm and 90 patients in the medical arm. For inclusion in the trial, the core size was required to be <70 cc and the ratio of ischemic tissue to infarct core 1.8 on perfusion imaging.…”

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confidence: 99%

Impact of expanding large vessel occlusion thrombectomy time-windows in inner city Detroit

et al. 2018

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confidence: 99%

Impact of expanding large vessel occlusion thrombectomy time-windows in inner city Detroit

et al. 2018

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“…CT remains the mainstay in the imaging triage of suspected AIS-LVO patients for ET, though there have been limited improvements in the non-contrast assessment of core infarction. The increased accuracy of VIM core infarct delineation over NCCT is of particular clinical relevance given established core volume thresholds in determining ET candidacy [14,99,107,108]. While our findings also suggest that VIM more accurately estimated core infarction than CTP, commonly applied CBF<30% segmentation thresholds underestimate the core volume relative to a less restrictive CBF<38% threshold to reduce false exclusion of patients from ET [109].…”

Section: Discussionmentioning

confidence: 57%

“…CT perfusion has proven a valuable selection tool for endovascular therapy in recent years [99,108]. For CTP to be used as a selection tool it needs to be reliable and allow quantitative core-penumbra volume mismatch evaluation.…”

Section: Ct Perfusionmentioning

confidence: 99%

“…Previously reported custom DECT post-processing algorithms have suggested improved detection of cerebral ischemia by highlighting areas of cytotoxic edema after material separation using basis pairs of fat and calcium, or air and water, however these techniques have been technically limited and complex to interpret, or were not compared against reference standard DWI images [89,91]. As accurate core infarct delineation is critical in the triage of AIS-LVO patients to ET, CT techniques capable of superior core estimation are of high clinical relevance [14,98,99].…”

Section: Introductionmentioning

confidence: 99%

“…A number of perfusion parameter maps can be inferred from CTP by using kinetic tracer analysis. These parameter maps give a quantitative insight into the perfusion status of the brain and are often used for clinical decision making as they can differentiate between healthy, salvageable (penumbra) and lost (infarct core) brain tissue [14,99].…”

Section: Introductionmentioning

confidence: 99%

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Dual-energy CT and CT perfusion for improved CT stroke imaging

Ommen¹

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Cardiovascular diseases (CVDs) are the leading causes of death in the world. An estimated 17.9 million people died from a CVD worldwide in 2016. The majority, 85% of deaths, is caused by either a heart attack or a stroke[1]. In the Netherlands, 38199 people died of a CVD in 2018, of which 9176 died of a stroke[2]. Not only does stroke significantly contribute to mortality, it is also a leading cause of disability[3]. Because of the aging population, the number of stroke patients is expected to increase[4]. Strokes can be divided into two groups: 1) ischemic strokes caused by an arterial occlusion, for example by a (temporary) clot, and 2) hemorrhagic strokes caused by a rupture of a vessel[5]. In this thesis we will be focusing on ischemic strokes. Currently, treatment options for ischemic strokes are intravenous administration of tissue plasminogen activator (tPA) for clot dissolution, intra-arterial thrombolysis, and endovascular mechanical clot removal[6]. Therapeutic interventions are most effective when initiated in the early stages after a stroke[7-9]. Guidelines state that intravenous thrombolysis should only be administered to patients within 4.5 hours, and endovascular treatment should only be initiated within 6 hours of ischemic stroke symptom onset[10]. Brain tissue damage may be irreversible, and the loss of brain tissue continues while the arterial occlusion persists. Therefore in stroke care the phrase "time is brain" is often used, meaning that the diagnosis and treatment of a stroke should be as fast as possible. This explains why the preferred imaging modality for acute stroke imaging usually is computed tomography (CT)[11]. CT is fast, relatively cheap and widely available. The acute stroke imaging protocol usually consists of noncontrast CT, CT perfusion and CT angiography scans. CT imaging in stroke Non-contrast CT In stroke imaging, the first acquisition is non-contrast CT (NCCT) of the entire brain. The primary goal of NCCT is to differentiate between ischemic and hemorrhagic strokes. Since blood has a higher attenuation than brain tissue, it appears hyperdense on a CT scan and can therefore be easily detected (Figure 1.1A). In addition to differentiating ischemic from hemorrhagic strokes, NCCT also provides some information on the extent of cerebral ischemia. On NCCT, subtle loss of gray-white matter differentiation and evidence of swelling can be first indications of ischemic stroke[12]. The ischemic area appears hypodense on NCCT (Figure 1.1B). Figure 1.3 | Examples of contrast enhancement curves: A) arterial input function (AIF) and venous output function (VOF), B) gray matter (GM) and white matter (WM). The dashed line shows the partial volume corrected AIF. Figure 1.5 | Illustration of three dual-energy CT techniques. A) Dual-source DECT utilizes two X-ray tubes and two detectors to generate low-and high-energy spectra, B) rapid kV switching utilizes one X-ray tube and detector and switches rapidly between a low and high tube voltage and C) detector-based spectral CT utilizes one X-ray...

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Aspiration thrombectomy for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Hassan

Fifi

Zaidat

2023

Preprint

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Background: The purpose of this study was to report the safety and performance of aspiration thrombectomy for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment. Methods: This is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated with aspiration thrombectomy with the Penumbra System. This subset analysis included all patients in the registry who had anterior circulation LVO, an Alberta Stroke Program Early CT Score of at least 6, and late onset to treatment (>6 hours from stroke onset to puncture). Results: Of the 650 patients in the COMPLETE registry, 167 were included here. The rate of successful revascularization at the end of the procedure was 83.2% (139/167), the rate of good functional outcome (mRS 0-2) at 90 days was 55.4% (87/157), and the all-cause mortality rate at 90 days was 14.4% (24/167). No device-related serious adverse events (SAEs) occurred. Procedure-related SAEs occurred in 9 patients (5.4%) within 24 hours and in 12 patients (7.2%) overall. No significant difference was detected between the outcomes of patients with an onset to puncture time of greater than 6 hours and less than or equal to 12 hours and the outcomes of patients with an onset to puncture time of greater than 12 hours. Conclusions: For patients with AIS due to anterior circulation LVO and with late onset to treatment, aspiration thrombectomy with the Penumbra System appears to be safe and effective. The rates of good functional outcome and all-cause mortality from this study compared favorably with those rates from the medical management arms of the DAWN and DEFUSE-3 studies. Registration: URL: https://www.clinicaltrials.gov; Unique identifier:NCT03464565.

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Abstract 78: Time to Endovascular Treatment and Outcomes in the DAWN Trial

Cited by 28 publications

References 0 publications

Impact of expanding large vessel occlusion thrombectomy time-windows in inner city Detroit

Impact of expanding large vessel occlusion thrombectomy time-windows in inner city Detroit

Dual-energy CT and CT perfusion for improved CT stroke imaging

Aspiration thrombectomy for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

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