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The DAWN and DEFUSE 3 trials are two landmark stroke trials that have changed the treatment model for patients with large vessel occlusive stroke that appear within 6 to 24 hours after the onset of symptoms, opening up endovascular treatment for this extended window of time Indications
.
Magnetic resonance imaging (MRI) or computed tomography perfusion (CTP) of advanced imaging shows no clinical or tissue matching is the main means of diversion of these two studies, mesh former American Stroke Association and the European Stroke Organization guidelines are recommended for these patients Use CTP or MRI to check
.
.
Head before the American Stroke Association and the European Stroke Organization guidelines are recommended for these patients the choice of CTP or MRI
This multinational cohort study included consecutive patients with proximal anterior circulation occlusive stroke that occurred within 6 to 24 hours of the last visit from January 2014 to December 2020
.
The study was conducted at 15 locations in 5 countries in Europe and North America
Exposure factors were computed tomography, CTP or MRI of the early CT score of the Alberta Stroke Project
.
The main outcome was the distribution of modified Rankin Scale (mRS) scores at 90 days
The results showed that of the 2304 patients screened out, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.
9%) were women
.
A total of 534 patients were selected for mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI
In general, after adjusting for confounding factors, patients selected by CT and CTP (OR=0.
95[95%CI, 0.
77-1.
17]) or CT and MRI (OR=0.
95[95%CI, 0.
8-1.
13) There was no difference in the sequence of mRS transfer within the day
.
The 90-day functional independence rate (mRS score 0-2 vs 3-6) of patients selected by CT and CTP was similar (aOR=0.
In general, after adjusting for confounding factors, patients selected by CT and CTP (OR=0.
90-day mRS in patients with internal carotid artery and middle cerebral artery M1/M2 occlusion within 6 to 24 hours after the last visit
Compared with the MRI group, the CT and CTP group had a higher success rate of reperfusion (474 [88.
9%] and 670 [89.
5%] vs 250 [78.
9%]; P <.
001)
.
Symptomatic intracranial hemorrhage (CT, 42[8.
Compared with the MRI group, the CT and CTP group had a higher success rate of reperfusion (474 [88.
In summary, in patients who underwent mechanical thrombectomy in the proximal anterior circulation within an extended time window, there was no significant difference in clinical results between non-enhanced CT and CTP or MRI
references:
Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.
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