Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours

Amin Aghaebrahim, Carlos Leiva-Salinas, Ashutosh P. Jadhav, Brian Jankowitz, Syed Zaidi, Mouhammad Jumaa, Xabi Urra, Edilberto Amorim, Guangming Zhu, Dan-Victor Giurgiutiu, Anat Horev, Vivek Reddy, Maxim Hammer, Lawrence Wechsler, Max Wintermark, Tudor Jovin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW). Methods: A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment. Results: We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38%, n=78) and (2) patients with witnessed onset beyond 8 h (62%, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43% vs 50%, p=0.3), parenchymal hematoma (9% vs 5.5%, p=0.3), and final infarct volume (75.2 vs 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95% CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95% CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes. Conclusions: Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.

Original languageEnglish (US)
Pages (from-to)875-880
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume7
Issue number12
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Stroke
Therapeutics
Hematoma
National Institutes of Health (U.S.)
Reperfusion
Multivariate Analysis
Databases

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours. / Aghaebrahim, Amin; Leiva-Salinas, Carlos; Jadhav, Ashutosh P.; Jankowitz, Brian; Zaidi, Syed; Jumaa, Mouhammad; Urra, Xabi; Amorim, Edilberto; Zhu, Guangming; Giurgiutiu, Dan-Victor; Horev, Anat; Reddy, Vivek; Hammer, Maxim; Wechsler, Lawrence; Wintermark, Max; Jovin, Tudor.

In: Journal of NeuroInterventional Surgery, Vol. 7, No. 12, 01.01.2015, p. 875-880.

Research output: Contribution to journalArticle

Aghaebrahim, A, Leiva-Salinas, C, Jadhav, AP, Jankowitz, B, Zaidi, S, Jumaa, M, Urra, X, Amorim, E, Zhu, G, Giurgiutiu, D-V, Horev, A, Reddy, V, Hammer, M, Wechsler, L, Wintermark, M & Jovin, T 2015, 'Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours', Journal of NeuroInterventional Surgery, vol. 7, no. 12, pp. 875-880. https://doi.org/10.1136/neurintsurg-2014-011316
Aghaebrahim, Amin ; Leiva-Salinas, Carlos ; Jadhav, Ashutosh P. ; Jankowitz, Brian ; Zaidi, Syed ; Jumaa, Mouhammad ; Urra, Xabi ; Amorim, Edilberto ; Zhu, Guangming ; Giurgiutiu, Dan-Victor ; Horev, Anat ; Reddy, Vivek ; Hammer, Maxim ; Wechsler, Lawrence ; Wintermark, Max ; Jovin, Tudor. / Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours. In: Journal of NeuroInterventional Surgery. 2015 ; Vol. 7, No. 12. pp. 875-880.
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title = "Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours",
abstract = "Objective: Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW). Methods: A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment. Results: We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38{\%}, n=78) and (2) patients with witnessed onset beyond 8 h (62{\%}, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43{\%} vs 50{\%}, p=0.3), parenchymal hematoma (9{\%} vs 5.5{\%}, p=0.3), and final infarct volume (75.2 vs 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95{\%} CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95{\%} CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95{\%} CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes. Conclusions: Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.",
author = "Amin Aghaebrahim and Carlos Leiva-Salinas and Jadhav, {Ashutosh P.} and Brian Jankowitz and Syed Zaidi and Mouhammad Jumaa and Xabi Urra and Edilberto Amorim and Guangming Zhu and Dan-Victor Giurgiutiu and Anat Horev and Vivek Reddy and Maxim Hammer and Lawrence Wechsler and Max Wintermark and Tudor Jovin",
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T1 - Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours

AU - Aghaebrahim, Amin

AU - Leiva-Salinas, Carlos

AU - Jadhav, Ashutosh P.

AU - Jankowitz, Brian

AU - Zaidi, Syed

AU - Jumaa, Mouhammad

AU - Urra, Xabi

AU - Amorim, Edilberto

AU - Zhu, Guangming

AU - Giurgiutiu, Dan-Victor

AU - Horev, Anat

AU - Reddy, Vivek

AU - Hammer, Maxim

AU - Wechsler, Lawrence

AU - Wintermark, Max

AU - Jovin, Tudor

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objective: Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW). Methods: A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment. Results: We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38%, n=78) and (2) patients with witnessed onset beyond 8 h (62%, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43% vs 50%, p=0.3), parenchymal hematoma (9% vs 5.5%, p=0.3), and final infarct volume (75.2 vs 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95% CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95% CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes. Conclusions: Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.

AB - Objective: Previous studies have suggested that patients with wake-up stroke (WUS) may have superior outcomes compared with patients with a witnessed late time of onset after revascularization. We sought to test this hypothesis in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy beyond 8 h from time last seen well (TLSW). Methods: A single center retrospective review of a prospectively acquired database of consecutive patients was performed to identify patients presenting beyond 8 h of TLSW with radiographic evidence of ACLVOS, small core, and large penumbra who subsequently underwent endovascular treatment. Results: We identified 206 patients. Patients were divided into two groups: (1) patients with WUS (38%, n=78) and (2) patients with witnessed onset beyond 8 h (62%, n=128). The groups were similar in age, baseline National Institutes of Health Stroke Scale score, TLSW to reperfusion, baseline infarct volume, and rate of successful recanalization. Rates of good outcome (modified Rankin Scale score of 0-2 at 90 days, 43% vs 50%, p=0.3), parenchymal hematoma (9% vs 5.5%, p=0.3), and final infarct volume (75.2 vs 61.4 mL, p=0.6) were comparable. Multivariate analysis identified age (OR=0.95, 95% CI 0.91 to 0.99, p<0.042), successful recanalization (OR 6.0, 95% CI 1.5 to 23.5, p=0.009), and final infarct volume (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) but not mode of presentation as predictors of favorable outcomes. Conclusions: Rates of good outcomes, parenchymal hematoma, and final infarct volumes following endovascular treatment may not be different in patients with WUS compared with patients with witnessed onset of symptoms beyond 8 h.

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