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Collaterals Predict Outcome Regardless of Time Last Known Normal
- Source :
- Journal of Stroke and Cerebrovascular Diseases. 27:971-977
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background and Purpose Recent studies suggest that patients with large-vessel ischemic strokes (large-vessel occlusion [LVO]) with favorable imaging may benefit from mechanical thrombolysis even when treated outside the standard 6-hour window. However, many patients in these studies presented with unknown times of onset. We compare outcomes in thrombectomy patients treated at less than versus greater than 6 hours from last known well (LKN), and evaluate whether “unknown time of onset“ alters prognosis. Methods We retrospectively reviewed patients at 2 comprehensive stroke centers. Student's t and chi-square tests evaluated the association between predetermined clinical and radiographic variables, including unknown time of onset, and outcome (discharge and follow-up National Institutes of Health Stroke Scale score and modified Rankin Scale [mRS] score) for LVOs treated after greater than 6 hours versus 6 hours or less from LKN. Multivariable logistic regression was used to determine the odds of good outcome (mRS score 0-2). Results A total of 113 patients were treated over 2 years; 31 were treated at greater than 6 hours. Those who were treated at greater than 6 hours and experienced poor outcomes were more likely to have large-artery atherosclerosis (P = .033). There was no difference in outcome for patients outside the window with known (39.1%) versus unknown (60.9%) time of onset. mRS scores at discharge were higher among those outside the window (odds ratio 3.78; 95% confidence interval 1.20-11.89) but not at follow-up. After multivariable regression, favorable collaterals alone were associated with a mRS score of 0-2. Conclusions When imaging is favorable, the mRS score at follow-up is comparable regardless of time LKN. Functional outcomes appear to be driven most significantly by the presence of collaterals.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Mechanical Thrombolysis
Collateral Circulation
030204 cardiovascular system & hematology
Logistic regression
Brain Ischemia
Time-to-Treatment
Odds
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Risk Factors
Modified Rankin Scale
Internal medicine
Occlusion
Odds Ratio
medicine
Humans
Stroke
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
Rehabilitation
Recovery of Function
Odds ratio
Middle Aged
medicine.disease
Outcome (probability)
Confidence interval
Logistic Models
Treatment Outcome
Cerebrovascular Circulation
Multivariate Analysis
Cardiology
Female
Surgery
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 10523057
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Journal of Stroke and Cerebrovascular Diseases
- Accession number :
- edsair.doi.dedup.....5506c9a03b961bafb5ed493f9f9bf15e