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Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020 : Rates and outcomes in a nationwide register-based study

Ullberg, Teresa LU ; Von Euler, Mia ; Wester, Per ; Arnberg, Fabian ; Norrving, Bo LU ; Andersson, Tommy and Wassélius, Johan LU (2023) In Journal of NeuroInterventional Surgery 15(4). p.330-335
Abstract

Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden. Methods: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (<6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes,... (More)

Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden. Methods: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (<6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes, and symptomatic intracerebral hemorrhage (sICH) was the safety outcome. Results: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509; 141 known onset, 368 LSW). Median age was 73 years, and 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window 42.4%, late window known onset 38.9%, late window LSW 37.3% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window 4.0%, late window known onset 2.1%, late window LSW 4.9% (p=0.413)). Conclusion: Late window EVTs have increased substantially over time, and currently account for one third of anterior circulation treatments. Early and late window patients had similar outcomes.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
CT perfusion, Stroke, Thrombectomy, Thrombolysis
in
Journal of NeuroInterventional Surgery
volume
15
issue
4
pages
330 - 335
publisher
BMJ Publishing Group
external identifiers
  • scopus:85127482566
  • pmid:35301261
ISSN
1759-8478
DOI
10.1136/neurintsurg-2022-018670
language
English
LU publication?
yes
id
4c5381b2-12fe-4824-89c7-98cf5d902de8
date added to LUP
2022-06-01 13:57:34
date last changed
2023-10-26 14:58:30
@article{4c5381b2-12fe-4824-89c7-98cf5d902de8,
  abstract     = {{<p>Background: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden. Methods: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (&lt;6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes, and symptomatic intracerebral hemorrhage (sICH) was the safety outcome. Results: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509; 141 known onset, 368 LSW). Median age was 73 years, and 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window 42.4%, late window known onset 38.9%, late window LSW 37.3% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window 4.0%, late window known onset 2.1%, late window LSW 4.9% (p=0.413)). Conclusion: Late window EVTs have increased substantially over time, and currently account for one third of anterior circulation treatments. Early and late window patients had similar outcomes.</p>}},
  author       = {{Ullberg, Teresa and Von Euler, Mia and Wester, Per and Arnberg, Fabian and Norrving, Bo and Andersson, Tommy and Wassélius, Johan}},
  issn         = {{1759-8478}},
  keywords     = {{CT perfusion; Stroke; Thrombectomy; Thrombolysis}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{330--335}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Journal of NeuroInterventional Surgery}},
  title        = {{Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020 : Rates and outcomes in a nationwide register-based study}},
  url          = {{http://dx.doi.org/10.1136/neurintsurg-2022-018670}},
  doi          = {{10.1136/neurintsurg-2022-018670}},
  volume       = {{15}},
  year         = {{2023}},
}