Background and Purpose

To provide real-world data on outcome and procedural factors of late thrombectomy patients.

Methods

We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2).

Results

Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6–24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes.

Conclusion

In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6–24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.

中文翻译：

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临床实践中的晚期血栓切除术

背景和目的

提供有关晚期血栓切除术患者的结果和手术因素的真实数据。

方法

我们回顾性分析了来自德国多中心卒中登记处的患者。主要终点是 3 个月时改良 Rankin 量表 (mRS) 的临床结果。将符合试验资格的患者和亚组与不符合试验资格的患者组进行比较。二次分析包括多变量逻辑回归以确定良好结果的预测因子（mRS  ≤  2）。

结果

在 1917 名接受血栓切除术的患者中，208 名 (11%) 在 ≥ 6-24 小时的时间窗口内接受治疗，并符合基线试验标准。其中，27 名患者 (13%) 符合 DAWN 条件，39 名患者 (19%) 符合 DEFUSE3 条件，156 名患者不符合 DAWN 或 DEFUSE3 条件 (75%)，主要是因为没有灌注成像 (62%；n = 129  ) ）。不符合试验资格的患者 (27%) 的良好结局并不显着高于符合试验资格的患者 (20%) ( p  = 0.343)。具有不符合试验资格的大面积 CT 灌注成像 (CTP) 病变的患者出血并发症明显增多 (33%)，并且预后不良。

结论

在临床实践中，像DAWN/DEFUSE3那样，大量患者在血管内治疗≥6-24小时后获得良好的临床结果是不可能的。根据 CTP 以外的因素选择 EVT ≥ 6 小时的患者也出现类似的结果。未进行 CTP 分诊的患者表现出到达再灌注时间更短和独立率更高的趋势。