Yield of ASPECTS and Collateral CTA Selection for Mechanical Thrombectomy within 6–24 hours from Symptom Onset in a Hub and Spoke System |
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| Institution: | 1. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN USA;2. Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis USA;3. Second Department of Neurology, Attikon University General Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece;1. Department of Neurology, University of Miami Miller School of Medicine, Miami, FL;2. Department of Neurology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY;3. Department of Epidemiology, Mailman School of Public Health, and Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY;4. Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL;1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China;2. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, China;3. The George Institute for Global Health at Peking University Health Science Center, Beijing, China;4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;5. Department of Ultrasound, Huaian Hospital of Huaian City, Huaian, Jiangsu, China;1. Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA;2. School of Medicine, Stony Brook University, Stony Brook, NY, USA;1. Clinical Research Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Chile;2. Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;3. Department of General Emergency, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;4. Genetic and Genomic Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;5. Department of Imaging, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;6. Department of Pediatrics and Ginecology, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile;7. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia;1. School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan;2. Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan;4. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan;5. Department of Community Mental Health & Low, National Center of Neurology and Psychiatry, Tokyo, Japan;6. Department of Dementia and Neuropsychology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan;7. Department of Cognition and Behavioral Science, Nagoya University Graduate School of Medicine, Aichi, Japan;1. University of Iowa Carver College of Medicine, United States;2. University of Iowa, Neurology Residency, United States;3. University of Iowa, Neuroradiology Department, United States;4. University of Iowa, Neurology Department, 200 Hawkins Drive, Iowa City IA 52242, United States;5. Iowa City VA Medical Center, United States |
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| Abstract: | BackgroundRecent extended window trials support the benefit of mechanical thrombectomy in anterior circulation large vessel occlusions with clinical-radiographic dissociation. Using trial imaging criteria, 6% were found eligible for MT in the EW in a hub-and-spoke system. We examined the eligibility and outcomes in consecutive extended window-mechanical thrombectomy patients using more pragmatic selection criteria.MethodsWe retrospectively analyzed single-institution data of anterior circulation large vessel occlusions patients presenting between 6–24 h who underwent mechanical thrombectomy based on a priori determined criteria including non-contrast CT head ASPECTS ≥ 6 and/or CTA collateral scores ASITN/SIR 2-4. Primary outcomes consisted of post-mechanical thrombectomy TICI 2b-3 and 3-month modified Rankin scores; safety outcomes consisted of in-hospital mortality and symptomatic intracerebral hemorrhage.Results767 consecutive acute ischemic strokes patients presented within the 6-24 hour window, and of these 48 (6%) anterior circulation large vessel occlusions patients underwent mechanical thrombectomy. In this cohort the mean age was 63±17 years, 56% were male, the median NIHSS was 16 IQR 10–19], the median ASPECTS was 9 (IQR 8-10), and 79% (n=38) had good CTA collaterals. Occlusions were primarily M1 MCA (46%), with 29% tandem occlusions. Successful recanalization (mTICI 2b or 3) was achieved in 73% (n=35), while 6% (n=3) of patients developed symptomatic intracerebral hemorrhage. In-hospital mortality was 25% (n=12) while 40% (n=19) achieved 3-month modified Rankin Scores 0–2.ConclusionsOur data suggest the use of pragmatic imaging approach of ASPECTS ≥6 with CTA collateral grade in extended time window which is already established in most hospitals. |
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