Abstract TMP11: Endovascular Treatment for Acute Ischemic Stroke in the Within 6-Hour versus 6-24-Hour Window: Simple Imaging Protocol
Introduction: DAWN and DEFUSE 3 trials utilized advanced imaging to prove the benefit of endovascular treatment (EVT) in patients within 6-24 hours. There is increasing evidence to suggest the limitations of advanced imaging in real-world practice. Non-contrast-enhanced computed tomography (NCCT) has proved with good sensitivity and specificity in the definition of infarct core. It is still unknown if a simpler and faster protocol may adequately select patients within 6-24 hours for EVT. Hypothesis: To compare outcomes of patients submitted to EVT presenting within 6 hours or 6-24 hours, selected using simple imaging protocol. Methods: An observational study was performed, which included consecutive patients with anterior circulation ischemic stroke eligible for EVT within 6 hours or 6-24 hours. Patients within early window received routine treatment, while patients presenting within late window were treated if they had a mismatch between the clinical deficit, the infarct volume, and collateral blood blow: (NIHSS score was ≥10 and ASPECTS was ≥7) or (ASPECTS was =6, and the collateral score was ≥2). ASPECTS of NCCT/DWI-MRI and collateral status on CTA/DSA were assessed by a blinded neuroradiologist. The collateral grading system was scored on a scale of 0-3 as in the ESCAPE trial. Results: Of the 184 patients were included, 77 (41,8%) received thrombectomy in late window, 107 (58,2%) received acute treatment in early window. Baseline characteristics were similar between groups, except for longer onset to groin puncture time (median, 300 vs 705 min; P<0,0001), higher admission NIHSS (median, 13 vs 16; P<0,0001), lower in ASPECTS (median, 9 vs 8; P<0,0001), and large artery atherosclerosis etiology (61,7 vs 72,7%, P=0,002) in the late window group. No significant differences in successful reperfusion rate and rates of parenchymal hematoma type 2 (81,3 vs 83,1%, P=0,75; 4/107 vs 4/77, P=0,63, respectively). Functional independence (mRS 0-2) and mortality at 90 days did not differ significantly (65,4 vs 57,1%, P=0,25; 10,3 vs 6,5%, P=0,43; respectively). Conclusions: This real-world observational study suggests that EVT may be safe and effective in patients presenting within 6-24 hours selected using clinical-core mismatch and collateral blood blow.