PMID- 36367319 OWN - NLM STAT- MEDLINE DCOM- 20230629 LR - 20230703 IS - 1747-4949 (Electronic) IS - 1747-4930 (Linking) VI - 18 IP - 6 DP - 2023 Jul TI - Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients. PG - 697-703 LID - 10.1177/17474930221140793 [doi] AB - BACKGROUND: The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with anterior circulation large vessel occlusions (LVO) up to 24 h after stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a broader range of patients presenting between 6 and 24 h. AIMS: We determined whether fulfilling the DEFUSE-3 and DAWN selection criteria affects outcomes in MT patients in clinical practice. METHODS: We reviewed adult patients with LVO treated with MT between 6 and 24 h after stroke onset at five Swiss stroke centers between 2014 and 2021. We compared two groups: (1) patients who satisfied neither DEFUSE-3 nor DAWN criteria (NDND) and (2) those who satisfied DEFUSE-3 or DAWN criteria (DOD). We used logistic regression to examine the impact of trial eligibility on two safety outcomes (symptomatic intracranial hemorrhage [sICH] and all-cause mortality at 3 months) and two efficacy outcomes (modified Rankin Score [mRS] shift toward lower categories and mRS of 0-2 at 3 months). RESULTS: Of 174 patients who received MT, 102 (59%) belonged to the NDND group. Rates of sICH were similar between the NDND group and the DOD group (3% vs. 4%, p = 1.00). Multivariable regression revealed no differences in 3-month all-cause mortality (aOR 2.07, 95% CI 0.64-6.84, p = 0.23) or functional outcomes (mRS shift: acOR 0.81, 95% CI 0.37-1.79, p = 0.60; mRS 0-2: aOR 0.91, 95% CI 0.31-2.57, p = 0.85). CONCLUSION: Among adult patients with LVO treated with MT between 6 and 24 h, safety and efficacy outcomes were similar between DEFUSE-3/DAWN eligible and ineligible patients. Our data provide a compelling rationale for randomized trials with broader inclusion criteria for MT. FAU - Dittrich, Tolga D AU - Dittrich TD AUID- ORCID: 0000-0002-9987-3631 AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Sporns, Peter B AU - Sporns PB AD - Department of Neuroradiology, University Hospital Basel, Basel, Switzerland. AD - Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Kriemler, Lilian F AU - Kriemler LF AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Clinic for Internal Medicine, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland. FAU - Rudin, Salome AU - Rudin S AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Nguyen, Anh AU - Nguyen A AD - Department of Neuroradiology, University Hospital Basel, Basel, Switzerland. FAU - Zietz, Annaelle AU - Zietz A AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Polymeris, Alexandros A AU - Polymeris AA AUID- ORCID: 0000-0002-9475-2208 AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Tranka, Christopher AU - Tranka C AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Thilemann, Sebastian AU - Thilemann S AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Wagner, Benjamin AU - Wagner B AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Altersberger, Valerian L AU - Altersberger VL AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Piot, Ines AU - Piot I AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Barinka, Filip AU - Barinka F AD - Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland. FAU - Hansel, Martin AU - Hansel M AD - Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Gensicke, Henrik AU - Gensicke H AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland. FAU - Engelter, Stefan T AU - Engelter ST AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland. FAU - Lyrer, Philippe A AU - Lyrer PA AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Sutter, Raoul AU - Sutter R AD - Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Nickel, Christian H AU - Nickel CH AD - Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Katan, Mira AU - Katan M AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Peters, Nils AU - Peters N AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland. FAU - Michels, Lars AU - Michels L AD - Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland. AD - Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland. FAU - Kulcsar, Zsolt AU - Kulcsar Z AD - Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland. FAU - Karwacki, Grzegorz M AU - Karwacki GM AD - Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland. FAU - Pileggi, Marco AU - Pileggi M AD - Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland. FAU - Cereda, Carlo AU - Cereda C AD - Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland. FAU - Wegener, Susanne AU - Wegener S AD - Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland. FAU - Bonati, Leo H AU - Bonati LH AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. AD - Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland. FAU - Fischer, Urs AU - Fischer U AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. FAU - Psychogios, Marios AU - Psychogios M AD - Department of Neuroradiology, University Hospital Basel, Basel, Switzerland. FAU - De Marchis, Gian Marco AU - De Marchis GM AD - Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20221214 PL - United States TA - Int J Stroke JT - International journal of stroke : official journal of the International Stroke Society JID - 101274068 SB - IM MH - Adult MH - Humans MH - *Brain Ischemia/surgery/etiology MH - Intracranial Hemorrhages/epidemiology/etiology MH - *Stroke/surgery/etiology MH - Thrombectomy/adverse effects MH - Treatment Outcome OTO - NOTNLM OT - Ischemic stroke OT - endovascular treatment OT - large vessel occlusion EDAT- 2022/11/12 06:00 MHDA- 2023/06/29 06:43 CRDT- 2022/11/11 08:03 PHST- 2023/06/29 06:43 [medline] PHST- 2022/11/12 06:00 [pubmed] PHST- 2022/11/11 08:03 [entrez] AID - 10.1177/17474930221140793 [doi] PST - ppublish SO - Int J Stroke. 2023 Jul;18(6):697-703. doi: 10.1177/17474930221140793. Epub 2022 Dec 14.