Background and Purpose:In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. We assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines–Stroke clinical registry.Methods:We analyzed all acute ischemic stroke patients treated with EVT between January 1, 2009 and October, 1, 2018, at Get With The Guidelines–Stroke hospitals in the United States. We assessed trends over time in frequency of EVT beyond 6 hours, compared patient characteristics and outcomes between those treated within versus beyond 6 hours, and evaluated the associations between EVT time and outcomes.Results:We identified 53 702 patients at 697 sites treated with EVT during the study period. Treatment after 6 hours from last known well occurred in 17 720 (33%) of all 53 702 EVT cases (median 4.7 hours, interquartile range, 3.3–7 hours). The proportion of EVT cases treated after 6 hours from last known well varied widely across sites (median 30%, interquartile range, 24%–38%). Compared with patients treated within 6 hours, those treated beyond six hours were younger, less likely to have atrial fibrillation, less likely to arrive by ambulance, had lower stroke severity, were less likely to be anticoagulated, and more likely to be treated at centers with higher EVT volumes. After adjusting for patient and hospital characteristics, patients receiving EVT beyond 6 hours had less favorable in-hospital mortality, ambulation at discharge, and discharge disposition compared to those treated within 6 hours.Conclusions:EVT is frequently performed for patients with ischemic stroke after 6 hours from last known well, accounting for one-third of cases nationally, and adjusted functional outcomes at discharge are worse in these patients compared to those treated with EVT within 6 hours. Further efforts are needed for optimal EVT outcomes in clinical practice settings.

中文翻译：

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美国临床实践中发病 6 小时以上中风患者血管内血栓切除术的频率、特征和结果

背景和目的：2018 年，2 项随机对照试验显示，使用影像学引导选择在距最后一次已知情况 6 至 24 小时内接受治疗的急性缺血性卒中患者中血管内血栓切除术 (EVT) 的益处。然而，对当代非试验环境中的结果知之甚少。我们评估了美国 Get With The Guidelines-Stroke 临床登记中 EVT 的频率和超过 6 小时的结果。方法：我们在 Get With 上分析了 2009 年 1 月 1 日至 2018 年 10 月 1 日期间接受 EVT 治疗的所有急性缺血性卒中患者指南——美国中风医院。我们评估了超过 6 小时的 EVT 频率随时间变化的趋势，比较了 6 小时内和 6 小时以上治疗的患者特征和结果，并评估了 EVT 时间和结果之间的关联。结果：在研究期间，我们在 697 个接受 EVT 治疗的地点确定了 53 702 名患者。在所有 53 702 例 EVT 病例中，有 17 720 例（33%）发生在距离最后一次已知良好状态 6 小时后的治疗（中位数 4.7 小时，四分位距，3.3-7 小时）。从最后一次众所周知的 6 小时后治疗的 EVT 病例的比例在不同地点差异很大（中位数 30%，四分位距，24%–38%）。与在 6 小时内接受治疗的患者相比，接受超过 6 小时治疗的患者更年轻、发生心房颤动的可能性更低、乘坐救护车到达的可能性更低、卒中严重程度更低、接受抗凝治疗的可能性更低，并且更有可能在中心接受治疗具有更高的 EVT 量。在对患者和医院特征进行调整后，接受 EVT 超过 6 小时的患者的住院死亡率、出院时的步行、与在 6 小时内接受治疗的患者相比，出院情况和出院情况。结论：缺血性卒中患者通常在距离最后一次确诊 6 小时后进行 EVT，占全国病例的三分之一，出院时调整后的功能结果在这些患者中更差与在 6 小时内接受 EVT 治疗的患者相比。需要进一步努力以在临床实践环境中获得最佳 EVT 结果。