Outcomes of Witnessed Versus Unwitnessed Patients With Stroke After Endovascular Therapy in the Extended Time Window.
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Tomppo Liisa, Martinez-Majander Nicolas, Qureshi Muhammad M, Nguyen Thanh N, Nogueira Raul G, Nagel Simon, Demeestere Jelle, Puetz Volker, Henon Hilde, Olive-Gadea Marta, Marto João Pedro, Dusart Anne, Ringleb Peter A, Zaidat Osama O, Haussen Diogo C, Mohammaden Mahmoud H, Abdalkader Mohamad, Raymond Jean, Ortega-Gutierrez Santiago, Sheth Sunil A, Yamagami Hiroshi, Ramos João Nuno, Caparros Francois, Kaiser Daniel P O, Ribo Marc, Salazar-Marioni Sergio, Tanaka Kanta, Virtanen Pekka, Puri Ajit S, Siegler James E, Zaidi Syed F, Jumaa Mouhammad, Lin Eugene, Mayol Jordi, Ventura Rita, Winzer Simon, Klein Piers, Bellante Flavio, Cespedes Jorge, Wouters Anke, Masoud Hesham E, Shu Liqi, Castonguay Alicia C, Herweh Christian, Cheng Monica, Hu Wei, Roy Daniel, Yaghi Shadi, Lemmens Robin, Cordonnier Charlotte, Möhlenbruch Markus A, Strbian Daniel
Аннотация
METHODS: We enrolled patients with anterior circulation large-vessel occlusion (internal carotid artery, M1, or M2 segment of the middle cerebral artery) undergoing endovascular thrombectomy within 6 to 24 hours from the time last seen well, from 2014 to 2022, at 66 sites in Europe, North America, and Asia. Patients with a prestroke modified Rankin Scale score of >3 or age <18 were excluded. We categorized patients by onset mode as witnessed or unwitnessed. The primary outcome was the modified Rankin Scale shift at 90 days. Secondary outcomes were functional independence, a composite of functional independence or return of Rankin to prestroke level, symptomatic intracranial hemorrhage, mortality, and a composite of severe disability or mortality at 90 days. We applied inverse probability of treatment weighting to compare outcomes between the groups.
RESULTS: Of 5098 patients assessed for eligibility, we included 2073, of whom 1760 (84.9%) had unwitnessed onset, and 313 (15.1%) were witnessed. In the univariate comparison (before inverse probability of treatment weighting), 38.8% of the unwitnessed and 45.7% of the witnessed patients achieved functional independence (P=0.022). Mortality was 21.6% among unwitnessed and 22.0% among witnessed (P=0.847), and symptomatic intracranial hemorrhage rates were 6.6% and 5.8%, respectively (P=0.623). The primary outcome (modified Rankin Scale shift) showed no difference comparing unwitnessed to witnessed patients (odds ratio, 1.35 [95% CI, 0.82-2.20]; P=0.235) in the inverse probability of treatment weighting. Unwitnessed patients were more likely to achieve functional independence or return of Rankin (1.53 [1.01-2.33]; P=0.045). Other secondary outcomes did not differ between the witnessed and unwitnessed patients.
CONCLUSIONS: In the extended time window, unwitnessed patients with large-vessel occlusion undergoing endovascular thrombectomy have at least the same likelihood of favorable outcomes as witnessed patients.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.