Association of Time Course of Thrombectomy and Outcomes for Large Acute Ischemic Region: RESCUE–Japan LIMIT Subanalysis

• Published in: Stroke: vascular and interventional neurology 2023-09, Vol.3 (5)
• Main Authors: Ishihara, Hideyuki, Nishimoto, Takuma, Shimokawa, Mototsugu, Oka, Fumiaki, Sakai, Nobuyuki, Yamagami, Hiroshi, Toyoda, Kazunori, Matsumaru, Yuji, Matsumoto, Yasushi, Kimura, Kazumi, Ishikura, Reiichi, Inoue, Manabu, Uchida, Kazutaka, Sakakibara, Fumihiro, Morimoto, Takeshi, Yoshimura, Shinichi
• Format: Article
• Language: English
• Subjects: acute ischemic stroke; endovascular treatment; Ischemia; large ischemic region; large vessel occlusion; Stroke
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.123.000880

BackgroundThe effectiveness of endovascular thrombectomy (EVT) has been proven even in patients with large cerebral infarction in the early time window. However, the association of the time course with the treatment effect is unknown. The aim of this analysis was to evaluate the influence of the time course from stroke onset to reperfusion on the therapeutic effect of EVT.MethodsThe subjects were patients with occlusion of large vessels and sizable strokes on imaging (Alberta Stroke Program Early Computed Tomographic score 3–5) in RESCUE–Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra‐Acute Embolism–Japan Large Ischemic Core Trial), a multicenter, randomized, clinical open‐label trial of EVT versus medical care alone. In the current analysis, the clinical and time course characteristics associated with a favorable outcome (modified Rankin scale [mRS] score of 0–2 and 0–3 at 90 days) were examined in patients treated with EVT.ResultsThe analysis included 71 patients (median age, 77 years; median National Institutes of Health Stroke Scale score on admission, 21). Occlusion sites were the internal carotid artery (48%), proximal segment of the middle cerebral artery (72%) and tandem lesions (20%). Of these patients, 23 (32%) had an mRS score of 0 to 3 and 12 (17%) had an mRS score of 0 to 2 at 90 days. In multivariate analysis, there were independent associations of onset to reperfusion time (odds ratio [OR], 0.991 [95% CI, 0.984–0.999]; P=0.01) and puncture to reperfusion time (OR , 0.952 [95% CI, 0.917–0.988]; P