Type

Journal Article

Authors

Sean Murphy
Barry Moynihan
David J Williams
Seamus Looby
Alan O'Hare
Paul Brennan
Sarah Power
John Thornton
Ronan Motyer

Subjects

Psychology

Topics
hours patient selection stroke national institute brain intervention network cerebral infarction

Endovascular thrombectomy beyond 12 hours of stroke onset: a stroke network's experience of late intervention. (2017)

Abstract Selected patients with proximal anterior circulation ischemic stroke who demonstrate limited infarct and sufficient penumbra may benefit from endovascular thrombectomy (EVT) beyond conventional time limits. To perform a retrospective review of all cases of EVT performed at our institution for proximal anterior circulation acute ischemic stroke with onset >12 hours. Patients were assessed with non-contrast CT brain and multiphase CT angiography, with Alberta Stroke Program Early CT Score (ASPECTS) and collateral grade informing patient selection. Data, including patient demographics, workflow, neuroimaging findings, procedural details, recanalization rates, and 90-day functional outcomes, were collected. Of the 542 consecutive endovascular thrombectomy cases performed during the study period, 25 (4.6%) were >12 hours from stroke onset. Median age was 69 years (IQR 55-80), median National Institute of Health Stroke Scale score on presentation was 14 (IQR 11-18.5), median ASPECTS was 8 (IQR 8-9), and rate of moderate-good collateral status was 96% (n=24). Median time to groin puncture was 14 hours 40 min (IQR 12 hours 36 min - 16 hours 18 min). Rate of successful recanalization (modified Thrombolysis in Cerebral infarction 2b-3) was 88% (n=22). Rate of functional independence (90-day modified Rankin Scale score 0-2) was 52% (n=13). There were no cases of symptomatic intracranial haemorrhage and 90-day mortality rate was 12% (n=3). With the use of ASPECTS and collateral grade to guide patient selection, good functional outcome with acceptable safety parameters may be achieved in patients undergoing EVT beyond 12 hours from stroke onset.
Collections Ireland -> Royal College of Surgeons in Ireland -> PubMed

Full list of authors on original publication

Sean Murphy, Barry Moynihan, David J Williams, Seamus Looby, Alan O'Hare, Paul Brennan, Sarah Power, John Thornton, Ronan Motyer

Experts in our system

1
Sean Murphy
University College Dublin
Total Publications: 39
 
2
David Williams
Royal College of Surgeons in Ireland
Total Publications: 96
 
3
Seamus Looby
Royal College of Surgeons in Ireland
 
4
Paul Brennan
Dublin City University
Total Publications: 41
 
5
John Thornton
Royal College of Surgeons in Ireland
Total Publications: 11