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- Title
Effect of Time Window on Endovascular Thrombectomy with or without Intravenous Thrombolysis in Acute Ischemic Stroke: Results from DIRECT-MT.
- Authors
Deng, Qiwen; Zhang, Lei; Liu, Yukai; Zhou, Feng; Yuan, Zhenhua; Wang, Xixi; Gao, Jie; Yang, Pengfei; Zhang, Yongwei; Xing, Pengfei; Li, Zifu; Hong, Bo; Han, Hongxing; Shi, Huaizhang; Shi, Hongchao; Liu, Jianmin
- Abstract
Introduction: Whether time window affects the intravenous thrombolysis (IVT) effect before endovascular thrombectomy (EVT) is uncertain. We aimed to investigate the effect of different time windows (0–3 h and >3–4.5 h from stroke onset to randomization) on clinical outcomes of EVT with or without IVT in a subgroup analysis of DIRECT-MT. Methods: The primary outcome was the 90-day modified Rankin Scale (mRS) according to time window. Logistic regression models were used to analyze the effect of different treatments (EVT with or without IVT) on outcomes within 0–3 h or >3–4.5 h. Results: Among 656 patients who were included in the analysis, 282 (43.0%) were randomized within >3–4.5 h after stroke onset (125 without IVT and 157 with IVT), and 374 (57.0%) were randomized within 0–3 h (202 without IVT and 172 with IVT). We noted no significant difference in the thrombectomy-alone effect between the time window subgroups according to 90-day ordinal mRS (adjusted common odds ratio [acOR] in patients within 0–3 h: 1.06 [95% CI: 0.73–1.52], acOR in patients within >3–4.5 h: 1.19 [95% CI: 0.78–1.82]) and 90-day functional independence. Thrombectomy alone resulted in an increased proportion of patients with 90-day mRS 0–3 treated within >3–4.5 h (62.90 vs. 48.72%) but not within 0–3 h (65.84 vs. 63.95%). However, there was no interaction effect regarding all outcomes after the Bonferroni correction. Conclusions: Our results did not support thrombectomy-alone administration within 3–4.5 h in patients with acute ischemic stroke from large-vessel occlusion in the subgroup analysis of DIRECT-MT.
- Subjects
ISCHEMIC stroke; ENDOVASCULAR surgery; STROKE patients; THROMBOLYTIC therapy; TREATMENT effectiveness
- Publication
Cerebrovascular Diseases, 2024, Vol 53, Issue 2, p176
- ISSN
1015-9770
- Publication type
Article
- DOI
10.1159/000533231