Association of Thrombectomy With Functional Outcome for Patients With Ischemic Stroke Who Presented in the Extended Time Window With Extensive Signs of Infarction
Authors: Broocks Gabriel , Hanning Uta , Bechstein Matthias , Elsayed Sarah , Faizy Tobias D. , Brekenfeld Caspar , Flottmann Fabian , Kniep Helge , Deb-Chatterji Milani , Schön Gerhard , Thomalla Götz , Kemmling André , Fiehler Jens , Meyer Lukas ,   German Stroke Registry–Endovascular Treatment (GSR-ET) Study Group, Boeckh-Behrens Tobias , Wunderlich Silke , Wiesmann Martin , Reich Arno , Ernemann Ulrike , Hauser Till-Karsten , Siebert Eberhard , Nolte Christian , Zweynert Sarah , Bohner Georg , Ludolph Alexander , Henn Karl-Heinz , Pfelschifter Waltraud , Wagner Marlis , Röther Joachim , Eckert Benrd , Berrouschot Jörg , Bormann Albrecht , Alegiani Anna , Hattingen Elke , Petzold Gabor , Thonke Sven , Bangard Christopher , Kraemer Christoffer , Dichgans Martin , Wollenweber Frank , Kellert Lars , Dorn Franziska , Herzberg Moriz , Psychogios Marios , Liman Jan , Petersen Martina , Stögbauer Florian , Kraft Peter , Pham Mirko , Braun Michael , Hamann Gerhard , Gröschel Klaus , Uphaus Timo , Limmroth Volker 
Published: October 2022

ImportanceOnly limited data are available about a potential benefit associated with endovascular treatment (EVT) for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.ObjectiveTo assess the association of recanalization after EVT with functional outcomes for patients with ischemic stroke presenting in the extended time window who also show signs of extensive infarction.Design, Setting, and ParticipantsThis retrospective, multicenter cohort study included patients enrolled in the German Stroke Registry–Endovascular Treatment with an Alberta Stroke Program Early CT Score (ASPECTS) of 5 or less who presented between 6 and 24 hours after stroke onset and underwent computed tomography and subsequent EVT between July 1, 2015, and December 31, 2019.Main Outcomes and MeasuresThe primary end point was a modified Rankin Scale (mRS) score of 3 or less at day 90. The association between recanalization (defined as the occurrence of a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3) and outcome was assessed using logistic regression and inverse probability weighting analysis.InterventionEndovascular treatment.ResultsOf 5853 patients, 285 (5%; 146 men [51%]; median age, 73 years [IQR, 62-81 years]) met the inclusion criteria and were analyzed. Of these 285 patients, 79 (27.7%) had an mRS score of 3 or less at day 90. The rate of successful recanalization was 75% (215 of 285) and was independently associated with a higher probability of reaching an mRS score of 3 or less (adjusted odds ratio, 4.39; 95% CI, 1.79-10.72; P &amp;lt; .001). In inverse probability weighting analysis, a modified Thrombolysis in Cerebral Infarction Scale score of 2b or 3 was associated with a 19% increase (95% CI, 9%-29%; P &amp;lt; .001) in the probability for an mRS score of 3 or more. Multivariable logistic regression analysis suggested a significant treatment benefit associated with vessel recanalization in a time window of up to 17.6 hours and ASPECTS of 3 to 5. The rate of secondary symptomatic intracerebral hemorrhage was 6.3% (18 of 285).Conclusions and RelevanceIn this cohort study reflecting daily clinical practice, vessel recanalization for patients with a low ASPECTS and extended time window was associated with better functional outcomes in a time window up to 17.6 hours and ASPECTS of 3 to 5. The results of this study encourage current randomized clinical trials to enroll patients with a low ASPECTS, even within the extended time window.