Comparing extended versus standard time window for thrombectomy: caseload, patient characteristics, treatment rates and outcomes—a prospective single-centre study

Purpose New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. Methods All cons...

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Bibliographic Details
Published in:Neuroradiology 2021-04, Vol.63 (4), p.603-607
Main Authors: Gunda, Bence, Sipos, Ildikó, Stang, Rita, Böjti, Péter, Dobronyi, Levente, Takács, Tímea, Berényi, Tamás, Futácsi, Balázs, Barsi, Péter, Rudas, Gábor, Kis, Balázs, Szikora, István, Bereczki, Dániel
Format: Article
Language:English
Subjects:
Clinical outcomes
Emergency medical care
Guidelines
Imaging
Interventional Neuroradiology
Ischemia
Magnetic resonance imaging
Medical imaging
Medicine
Medicine & Public Health
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Occlusion
Patients
Radiology
Stroke
Target recognition
Veins & arteries
Windows (intervals)
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Summary:Purpose New guidelines recommend thrombectomy up to 24 h in selected patients; however, the workload and benefit of extending time window are not known. We conducted a prospective single-centre study to determine the caseload, imaging and interventional need of extended time window. Methods All consecutive ischemic stroke patients within 24 h from onset in an 11-month period were included. Thrombectomy eligibility in the 0–6 h time window was based on current guidelines; in the 6–24 h time window, it was based on a combination of DEFUSE 3 and DAWN study criteria using MRI to identify target mismatch. Clinical outcome in treated patients was assessed at 3 months. Results Within 24 h of onset, 437 patients were admitted. In the 0–6 h time window, 238 patients (54.5%) arrived of whom 221 (92.9%) underwent CTA or MRA, 82 (34.5%) had large vessel occlusion (LVO), 30 (12.6%) had thrombectomy and 11 (36.6%) became independent (mRS ≤ 2). In the extended 6–24 h time window, 199 patients (45.5%) arrived of whom 127 (63.8%) underwent CTA or MRA, 44 (22.1%) had LVO, 8 (4%) had thrombectomy and 4 (50%) became independent. Conclusion Extending the time window from 6 to 24 h results in a 26.7% increase in patients receiving thrombectomy and a 36.4% increase of independent clinical outcome in treated patients at the price of a significantly increased burden of clinical and imaging screening due to the similar caseload but a smaller proportion of treatment eligible patients in the extended as compared with the standard time window.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-020-02531-8