Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy
- Authors
- Kim, J-T; Cho, B-H; Choi, K-H; Park, M-S; Kim, B. J.; Park, J-M; Kang, K.; Lee, S. J.; Kim, J. G.; Cha, J-K; Kim, D-H; Nah, H-W; Park, T. H.; Park, S-S; Lee, K. B.; Lee, J.; Hong, K-S; Cho, Y-J; Park, H-K; Lee, B-C; Yu, K-H; Oh, M. S.; Kim, D-E; Ryu, W-S; Choi, J. C.; Kwon, J-H; Kim, W-J; Shin, D-, I; Sohn, S., I; Hong, J-H; Lee, J. S.; Bae, H-J; Saver, J. L.; Cho, K-H
- Issue Date
- Feb-2020
- Publisher
- Blackwell Publishing Inc.
- Keywords
- acute ischaemic stroke; DWI-ASPECTS; endovascular therapy; time to treatment
- Citation
- European Journal of Neurology, v.27, no.2, pp 343 - 351
- Pages
- 9
- Journal Title
- European Journal of Neurology
- Volume
- 27
- Number
- 2
- Start Page
- 343
- End Page
- 351
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/3162
- DOI
- 10.1111/ene.14083
- ISSN
- 1351-5101
1468-1331
- Abstract
- Background and purpose The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated. Methods This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8-10), moderate (5-7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0-2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated. Results Ultimately, 985 patients (age 69 +/- 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (P-interaction = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (P-nonlinearity = 0.15). Conclusions Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.
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Collections - College of Medicine > Department of Neurology > 1. Journal Articles
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