Association Between Time to Treatment and Outcomes of Endovascular Therapy vs Medical Management in Patients With Large Ischemic Stroke

作者：Guangxiong Yuan, Hongfei Sang, Thanh N. Nguyen, Xiaochuan Huo, Yuesong Pan, Mengxing Wang, Zhongming Qiu, Lei Liu, Hong Xia, Junxiong Wu, Chen Long, Jun Xu, Feng Huang, Bo He, Derong Wu, Hailing Wang, Can Feng, Yong Liang, X. Zhou, Wenbin Yang, Zhu Huang, Youxi Xiang, Libo Lei, Jeffrey L. Saver, Zhongrong Miao, Xueli Cai · 发表于：Neurology · 年份：2024 · DOI：10.1212/wnl.0000000000210133 · 被引用次数：8 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND AND OBJECTIVES: Randomized trials have proven the benefit of endovascular therapy (EVT) for acute large ischemic stroke. This study was to characterize the effect of time to treatment on benefit of EVT vs medical management (MM) among patients with large ischemic stroke. METHODS: This was a post hoc analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core randomized trial. Patients who had an Alberta Stroke Program Early Computed Tomography Score of 3-5 or an ischemic core volume of 70-100 mL within 24 hours of symptom onset were treated with EVT plus MM or MM. Onset-to-expected arterial puncture time (OPT) was analyzed as a categorical variable (<6, 6-<12, and 12-24 hours) using binary logistic regression and as a continuous variable using a multivariable fractional polynomial interaction. The primary efficacy outcome was favorable outcomes (modified Rankin Scale scores 0-3) at 90 days. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. RESULTS: interactions >0.10). DISCUSSION: These findings strengthen the benefit of EVT initiated within 13 hours and 22 minutes after symptom onset compared with MM alone in patients with large ischemic stroke, but EVT should not be withheld for patients presenting beyond 13 hours and 22 minutes. Pooled analysis of larger sample sizes is needed. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov; NCT04551664. CLASSIFICATION ...