Outcomes of endovascular treatment for acute large‐vessel ischaemic stroke more than 6 h after symptom onset

Motyer, Ronan; Kok, Hong Kuan; Asadi, Hamed; O’Hare, Ann M.; Brennan, Paul; Power, Sarah; Looby, Seamus; Nicholson, Patrick; Williams, David; Murphy, Seán; Hill, Michael D.; Goyal, Madhav; McManus, John; O'Brien, Páraig; Thornton, John

doi:10.1111/joim.12680

Cited by 10 publications

(7 citation statements)

References 50 publications

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“…It was noteworthy that patients with a history of myocardial infarction showed a marginal association ( p = 0.050) with ALI, partly because these patients always showed other risk factors for stroke ( 29 ). The severity scores were always influenced by these confounding factors, especially the OTT ( 30 , 31 ), which may partly account for these discrepancies.…”

Section: Discussionmentioning

confidence: 99%

Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke

Bai

Ning

et al. 2018

Front. Neurol.

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BackgroundAcute lung injury (ALI) is a serious complication of stroke that occurs with a high incidence. Our preclinical results indicated that ALI might be related to blood glutamate levels after brain injury. The purpose of this study was to assess dynamic changes in blood glutamate levels in patients with stroke and to determine the correlation between blood glutamate levels, ALI, and long-term prognosis after stroke.MethodsVenous blood samples were collected from controls and patients with stroke at admission and on the third and seventh day after the onset of stroke. Patients were followed for 3 months. The correlations among blood glutamate levels, severities of stroke and ALI, and long-term outcomes were analyzed, and the predictive values of blood glutamate levels and severity scores for ALI were assessed.ResultsIn this study, a total of 384 patients with stroke were enrolled, with a median age of 59 years. Patients showed significantly increased blood glutamate levels within 7 days of stroke onset (p < 0.05), and patients with more severe injuries showed higher blood glutamate levels. Moreover, blood glutamate levels were closely related to the occurrence (adjusted odds ratio, 3.022, p = 0.003) and severity (p < 0.001) of ALI and the long-term prognosis after stroke (p < 0.05), and they were a more accurate predictor of ALI than the more commonly used severity scores (p < 0.01).ConclusionThese results indicated that an increased blood glutamate level was closely related to the development of ALI and a poor prognosis after stroke.Clinical Trial Registration, identifier ChiCTR-RPC-15006770.

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Section: Discussionmentioning

confidence: 99%

Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke

Bai

Ning

et al. 2018

Front. Neurol.

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“…Furthermore, prior to these RCTs, several studies had challenged the 6-h time window. Some retrospective studies have shown that patients with AIS who had been treated with delayed EVT (>6 h after symptom onset) showed comparable efficacy and safety compared with patients with AIS who had been treated with early EVT (within 6 h after symptom onset) (10,11). These studies provided further evidence for delayed EVT in patients with AIS that needs consideration.…”

Section: Introductionmentioning

confidence: 95%

Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis

Liu

Wang

et al. 2021

Front. Neurol.

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Background: There is considerable evidence on the benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) within 6 h after symptom onset. However, uncertainties remain regarding EVT efficacy beyond 6 h after symptom onset. We undertook a meta-analysis to assess the efficacy and safety of EVT in patients with AIS >6 h after symptom onset.Methods: We searched PubMed, EMBASE, and Chinese Biomedical through July 2019. We included studies involving early (≤6 h) vs. delayed (>6 h) EVT in selected patients with AIS, based on radiological evaluation criteria. Functional independence, successful recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) rates were assessed.Results: Eight articles, with 3,265 patients who had undergone early EVT and 1,078 patients who had received delayed EVT, were included in the meta-analysis. Patients treated with early EVT showed a similar proportion of functional independence at 90 days [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.926–1.397, P = 0.219; I2 = 36.2%, P = 0.128] as those treated with delayed EVT. Delayed EVT was also associated with no significant difference in mortality (OR = 1.015, 95% CI = 0.852–1.209; P = 0.871; I2 = 0.0%, P = 0.527), successful recanalization (OR = 1.255, 95% CI = 0.923–1.705; P = 0.147; I2 = 60.5%, P = 0.009), and sICH (OR = 0.976, 95% CI = 0.737–1.293; P = 0.871; I2 = 0.0%, P = 0.742) rates compared with early EVT.Conclusions: Among selected patients with AIS, delayed EVT showed comparable outcomes in functional independence, recanalization, mortality, and sICH rates compared with early EVT.

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“…Ischaemic cores in patients with better collateral blood supply have been shown to progress more slowly and may benefit from thrombectomy and reperfusion at longer time intervals from symptom onset. 7 The thrombectomy service in Ireland currently accept patients up to 12 hours for anterior circulation stroke and 24 hours for posterior circulation stroke in those appropriate by imaging criteria. The Irish national DNT target including CT imaging is 30 min.…”

Section: Available Knowledgementioning

confidence: 99%

Quality improvement project to improve patient outcomes by reducing door to CT and door to needle time and increasing appropriate referrals for endovascular thrombectomy.

et al. 2022

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This paper describes a stroke quality improvement (QI) project in a primary stroke centre in a 431-bed hospital serving a local population of 114 000 people. Approximately 170 acute strokes are treated each year in a seven-bed stroke unit managed by three geriatricians with a subspecialty interest in stroke. 24-hour CT radiology service is available. Endovascular thrombectomy (EVT) is performed by neuro-interventional radiology at one of two comprehensive stroke centres located 90–120 min away.In 2018, as part of a national collaborative QI initiative a new national thrombectomy referral pathway was introduced with an aim that all eligible patients be referred for EVT. This initiative included maximising timely access to CT and thrombolysis. Review of local data highlighted significant deficits in these areas.A local QI team convened and a multidisciplinary approach was employed to map the existing process for CT access and time to thrombolysis decision.We describe how focused timesaving interventions such as; new emergency and radiology department ‘pre-alerts’, dedicated acute stroke pagers, new ‘FAST’ registration by clerical staff, new CT ordering codes and new ‘FAST packs’ (including tissue plasminogen activator, paper National Institute of Health Stroke Scale scoring tools, consent forms and EVT patient selection tools) were created and incorporated into a multidisciplinary detailed clinical stroke care pathway.We describe how we achieved our SMART aims; to reduce our door to CT time and to reduce our door to needle time to the national target of less than 30 min. A third aim was to increase the number of patients referred for EVT from our centre.This project is an accurate description of how a multidisciplinary approach combined with teamwork and effective communication can create sustainable improved patient care and is generalisable to all institutions that require timely referral to external centres for EVT.

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Outcomes of endovascular treatment for acute large‐vessel ischaemic stroke more than 6 h after symptom onset

Abstract: In appropriately selected patients, EVT >6 h was associated with comparable outcomes to those treated <6 h. These data support a physiological approach to patient selection.

Cited by 10 publications

References 50 publications

Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke

Blood Glutamate Levels Are Closely Related to Acute Lung Injury and Prognosis after Stroke

Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis

Quality improvement project to improve patient outcomes by reducing door to CT and door to needle time and increasing appropriate referrals for endovascular thrombectomy.

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