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It is not clear after the last patient in good health for 6 hours, how to identify possible from the blood vessels within the thrombus resection of the best imaging method (EVT) benefit patients
.
Six randomized clinical trials (RCTs) evaluated the efficacy of EVT and standard medical care in patients with ischemic stroke
Vascular Thrombosis Stroke
In order to comprehensively evaluate the above problems, experts from the Institute of Neurology at Stanford University evaluated the benefits of EVT in patients with three types of baseline imaging data through a pooled analysis of RCTs
.
All data comes from the AURORA (analysis of aggregated data from randomized studies of thrombectomy more than 6 hours after the last knowledge), which aggregates patient-level data from all clinical trials
Researchers searched online databases to identify RCTs for the treatment of intravascular stroke published between January 1, 2010 and March 1, 2021.
These trials recruited patients with ischemic stroke who were well informed the last time.
Randomly allocated within 6 to 24 hours
.
The main result was a reduction in disability as measured by the modified Rankin scale within 90 days
.
In addition, an evaluation was conducted to check whether the treatment response was different among the patients receiving treatment based on the imaging data of their last known good time
Among 505 eligible patients, 266 (mean [SD] age, 68.
4 [13.
8] years; 146 women [54.
9%]) were assigned to the EVT group, and 239 (mean [SD] age, 68.
7 [13.
7] ] Years old; 126 males [52.
7%]) were assigned to the control group
.
Among the 295 patients in the clinical mismatch subgroup and the 359 patients in the targeted perfusion mismatch subgroup, EVT had a lower disability rate after 90 days compared with no EVT (clinical mismatch subgroup, OR=3.
Among the 295 patients in the clinical mismatch subgroup and the 359 patients in the targeted perfusion mismatch subgroup, EVT had a lower disability rate after 90 days compared with no EVT (clinical mismatch subgroup, OR=3.
Statistical benefits were observed in all three trichotomies of the two subgroups, with the highest OR value of the trichotomies (clinical mismatch subgroup, OR=4.
Differences in 90-day mRs scores between the two groups
In addition, a total of 132 patients (26.
1%) had uncertain imaging data and no obvious therapeutic effect (OR=1.
59; 95%CI, 0.
82-3.
06)
.
The interaction between the clinical and targeted perfusion mismatch subgroup and the undetermined profile subgroup was significant (OR=2.
In summary, during the 6-24 hour treatment interval, EVT has similar benefits to patients in the clinically mismatched and targeted perfusion mismatched subgroups
.
These findings support EVT as a treatment method for patients who meet any of the imaging mismatch characteristics within a 6-24 hour interval
In summary, during the 6-24 hour treatment interval, EVT has similar benefits to patients in the clinically mismatched and targeted perfusion mismatched subgroups
references:
Assessment of Optimal Patient Selection for Endovascular Thrombectomy Beyond 6 Hours After Symptom Onset: A Pooled Analysis of the AURORA Database.
Assessment of Optimal Patient Selection for Endovascular Thrombectomy Beyond 6 Hours After Symptom Onset: A Pooled Analysis of the AURORA Database.
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