Selection of Candidates for Endovascular Treatment: Characteristics According to Three Different Selection Methods

Abstract

Background and Purpose To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status. Methods Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps. Results Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods. Conclusions Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.

Endovascular Treatment After Stroke Due to Large Vessel Occlusion for Patients Presenting Very Late From Time Last Known Well

“…Although the absolute number of additional candidates for EVT in the very late period is small, approximately one-third of the patients with LVO presenting 16 hours or more from the time LKW may benefit from the recanalization. A consensus has not been reached on the best imaging criteria to identify treatable tissues in clinical practice . The image criteria for the DEFUSE 3 trial may have the potential to determine the treatment response based our subgroup analyses, which requires further study …”

“…A consensus has not been reached on the best imaging criteria to identify treatable tissues in clinical practice. 33 The image criteria for the The final infarct growth from the baseline ischemic core as a ratio (A) and the final infarct growth from the baseline ischemic core as a volume (B) were similar. However, the extent of reperfused penumbra from the baseline penumbra volume greater than 6 seconds as a ratio (C) and the extent of reperfused penumbra from the baseline penumbra volume greater than 6 seconds as a volume DEFUSE 3 trial may have the potential to determine the treatment response based our subgroup analyses, which requires further study.…”

Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke

“…These are the Acute Stroke Registry and Analysis of Lausanne, 14 19 ; and the Seoul National University Bundang Hospital Stroke Registry (2011-2016). 20 Details regarding the included studies are summarized in Table S1. The main study was registered at PROSPERO (https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020222003) and the article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.…”

Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

“…Data from seven trials and registries were pooled for this analysis. These are the Acute STroke Registry and Analysis of Lausanne,8 Lausanne, Switzerland; the Beaumont Hospital Registry,9 Dublin, Ireland; the efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1) trial,10 the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial,4 the Italian Registry of Endovascular Thrombectomy (IRETAS),11 Italy; the Precise and Rapid Assessment of Collaterals Using Multiphase CTA in the Triage of Patients with Acute Ischemic Stroke for IV or IA Therapy (PRove-IT) study12; and the Seoul National University Bundang Hospital stroke registry 13. All included studies and registries were approved by local ethics review committees or analysed only anonymised data as permitted by local legislation.…”