Safety and efficacy of endovascular treatment for progressive large vessel occlusion stroke presenting 24-72 h after onset: a propensity score-matched analysis.
To evaluate the efficacy and safety of endovascular treatment (EVT) versus standard medical therapy (SMT) in patients with progressive large vessel occlusion (LVO) presenting 24-72 h after onset.
We retrospectively analyzed patients with progressive LVO and perfusion mismatch (tissue window) between 24 and 72 h after onset. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. Secondary outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH).
A total of 164 patients were included (EVT, n = 48; SMT, n = 116). The EVT group showed significantly better 90-day functional outcomes (median mRS: 3 [IQR 2-4] vs. 4 [IQR 3-6]; OR 1.86, 95% CI 1.13-5.25; p = 0.018) and higher functional independence rates (43.8% vs. 12.9%; OR 5.24, 95% CI 2.73-10.05; p < 0.001) compared with the SMT group. EVT was also associated with reduced severe disability or death (18.8% vs. 47.4%; OR 0.26, 95% CI 0.12-0.56; p < 0.001) and lower all-cause mortality (12.5% vs. 37.9%; OR 0.23, 95% CI 0.09-0.51; p = 0.001). The incidence of sICH did not differ significantly between groups (10.4% vs. 6.0%; OR 1.81, 95% CI 0.65-5.08; p = 0.409). These findings remained consistent after PSM and in sensitivity analyses excluding non-witnessed strokes. Subgroup analysis indicated that good collateral circulation (Tan 2-3) significantly predicted functional independence (73.1% vs. 9.1%; OR 27.14, 95% CI 4.83-152.45; p < 0.001).
For progressive LVO patients presenting 24-72 h after onset with favorable perfusion imaging, EVT was associated with improved functional outcomes and lower mortality, without a significant increase in hemorrhage risk. Furthermore, good collateral circulation is a statistically significant factor associated with EVT benefit.
We retrospectively analyzed patients with progressive LVO and perfusion mismatch (tissue window) between 24 and 72 h after onset. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. Secondary outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH).
A total of 164 patients were included (EVT, n = 48; SMT, n = 116). The EVT group showed significantly better 90-day functional outcomes (median mRS: 3 [IQR 2-4] vs. 4 [IQR 3-6]; OR 1.86, 95% CI 1.13-5.25; p = 0.018) and higher functional independence rates (43.8% vs. 12.9%; OR 5.24, 95% CI 2.73-10.05; p < 0.001) compared with the SMT group. EVT was also associated with reduced severe disability or death (18.8% vs. 47.4%; OR 0.26, 95% CI 0.12-0.56; p < 0.001) and lower all-cause mortality (12.5% vs. 37.9%; OR 0.23, 95% CI 0.09-0.51; p = 0.001). The incidence of sICH did not differ significantly between groups (10.4% vs. 6.0%; OR 1.81, 95% CI 0.65-5.08; p = 0.409). These findings remained consistent after PSM and in sensitivity analyses excluding non-witnessed strokes. Subgroup analysis indicated that good collateral circulation (Tan 2-3) significantly predicted functional independence (73.1% vs. 9.1%; OR 27.14, 95% CI 4.83-152.45; p < 0.001).
For progressive LVO patients presenting 24-72 h after onset with favorable perfusion imaging, EVT was associated with improved functional outcomes and lower mortality, without a significant increase in hemorrhage risk. Furthermore, good collateral circulation is a statistically significant factor associated with EVT benefit.
Authors
Guo Guo, Guo Guo, Chen Chen, Zhang Zhang, Pei Pei, Qiu Qiu, Liu Liu, Guo Guo, Bao Bao, Zhou Zhou, Wang Wang, Sun Sun
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