Premium
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
Author(s) -
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.,
Lee J.,
Bae H.J.,
Saver J. L.,
Cho K.H.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14083
Subject(s) - medicine , modified rankin scale , stroke (engine) , magnetic resonance imaging , groin , diffusion mri , outcome (game theory) , computed tomography , prospective cohort study , radiology , surgery , ischemic stroke , ischemia , mechanical engineering , engineering , mathematics , mathematical economics
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.