Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h.

Details

Serval ID
serval:BIB_A0E6E74B65E2
Type
Article: article from journal or magazin.
Collection
Publications
Title
Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h.
Journal
International Journal of Stroke : Official Journal of the International Stroke Society
Author(s)
Wouters A., Lemmens R., Christensen S., Wilms G., Dupont P., Mlynash M., Schneider A., Laage R., Cereda C.W., Lansberg M.G., Albers G.W., Thijs V., AXIS 2
Working group(s)
DEFUSE 2 study investigators
Contributor(s)
AXIS 2
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
11
Number
1
Pages
127-133
Language
english
Abstract
BACKGROUND: Recent trials have shown a clear benefit of endovascular therapy for stroke patients presenting within 6 h after stroke onset. Imaging-based selection may identify a cohort with a favorable response to endovascular therapy, in an even later time window.
AIMS: We performed an indirect comparison between outcomes seen in DEFUSE 2, a prospective cohort study of patients who received a baseline MRI before endovascular therapy, and a control group from AXIS 2 receiving standard medical care up to 12 h after symptom onset.
METHODS: Patients from AXIS 2 with a confirmed large vessel occlusion were selected as a control group for DEFUSE 2-patients. The primary endpoint was good functional outcome at day 90 (Modified Rankin Score 0-2). We performed a stratified analysis based on the presence of the target mismatch for both studies and reperfusion status in DEFUSE 2.
RESULTS: We compared good functional outcome in 108 patients from AXIS 2 and 99 patients from DEFUSE 2. In DEFUSE 2-patients with the target mismatch profile in whom reperfusion was achieved, the rate of good functional outcome was increased compared to target mismatch patients in AXIS 2, 54% versus 29% (OR 3.2, 95% CI 1.1-9.4). In target mismatch patients treated between 6 and 12 h after stroke onset, this association between study and good functional outcome remained present (OR 9.0, 95% CI 1.1-75.8).
CONCLUSIONS: This indirect comparison suggests that endovascular treatment resulting in substantial reperfusion is associated with improved outcome in target mismatch patients even beyond 6 h after stroke onset. Confirmation is needed from future clinical trials that randomize patients beyond the 6 h time window.
Pubmed
Create date
16/03/2016 18:05
Last modification date
20/08/2019 15:07
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