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Endovascular thrombectomy for anterior circulation stroke beyond 6 hours of onset in Sweden 2015 to 2020: rates and outcomes in a nationwide register-based study
Department of Diagnostic Radiology, Neuroradiology, Skåne University Hospital, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden.
Örebro University, School of Medical Sciences. Department of Neurology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-3845-8100
Department of Public Health and Clinical Science, Umeå University, Umeå, Sweden; Departments of Neuroradiology Department of Clinical Science, Karolinska Institute, Danderyds Hospital, Stockholm, Sweden.
Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: Journal of neurointerventional surgery, E-ISSN 1759-8486, Vol. 15, no 4, p. 330-335Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Endovascular thrombectomy (EVT) for ischemic stroke (IS) beyond 6 hours has been proven effective in randomized controlled trials. We present data on implementation and outcomes for EVT beyond 6 hours in Sweden.

METHODS: We included all cases of anterior circulation IS caused by occlusion of the intracranial carotid artery, and the M1 or M2 segment of the middle cerebral artery, registered in two nationwide quality registers for stroke in 2015-2020. Three groups were defined from onset-to-groin-puncture (OTG) time: early window (<6 hours), late window (6-24 hours) known onset, late window last seen well (LSW). Favorable outcome (modified Rankin Scale (mRS) 0-2) and all-cause mortality at 90 days were the main outcomes, and symptomatic intracerebral hemorrhage (sICH) was the safety outcome.

RESULTS: Late window EVT increased from 0.3% of all IS in 2015 to 1.8% in 2020, and from 17.4% of all anterior circulation EVTs in 2015 to 32.9% in 2020. Of 2199 patients, 76.9% (n=1690) were early window EVTs and 23.1% late window EVTs (n=509; 141 known onset, 368 LSW). Median age was 73 years, and 46.2% were female, with no differences between groups. Favorable outcome did not differ between groups (early window 42.4%, late window known onset 38.9%, late window LSW 37.3% (p=0.737)) and remained similar when adjusted for baseline differences. sICH rates did not differ (early window 4.0%, late window known onset 2.1%, late window LSW 4.9% (p=0.413)).

CONCLUSION: Late window EVTs have increased substantially over time, and currently account for one third of anterior circulation treatments. Early and late window patients had similar outcomes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023. Vol. 15, no 4, p. 330-335
Keywords [en]
CT perfusion, Stroke, Thrombectomy, Thrombolysis
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-98156DOI: 10.1136/neurintsurg-2022-018670ISI: 000771049800001PubMedID: 35301261Scopus ID: 2-s2.0-85150311660OAI: oai:DiVA.org:oru-98156DiVA, id: diva2:1645908
Funder
The Crafoord Foundation
Note

Funding agencies:

Regional ALF grants

SUS Stiftelser och Fonder

Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-01-02Bibliographically approved

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CiteExportLink to record
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