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<p>Current European Stroke Organisation (ESO) guidelines recommend extended time window reperfusion therapies (4.5–9&#xa0;h for thrombolysis, 6–24&#xa0;h for thrombectomy) based on advanced imaging. However, the workload and clinical benefit of this strategy on a population basis are not known. To determine the caseload, treatment rates, and outcomes in the extended as compared to the standard time windows. All consecutive ischaemic stroke patients within 24&#xa0;h of last known well between 1st March 2021 and 28th February 2022 were included in a prospective single-centre study. Treatment eligibility in the extended time windows or wake-up strokes recognized within 4&#xa0;h was based on current ESO guideline criteria using MRI DWI-PWI or DWI-FLAIR mismatch. MRI was only available during working hours (8–20&#xa0;h); otherwise, CT/CTA was used. Clinical outcome in treated patients was assessed at three months. Among the 777 admitted patients, 252 (32.4%) had MRI. The thrombolysis rate was 119/304 (39.1%) in standard and 14/231 (6.1%) in the extended time window. The thrombectomy rate was 34/386 (8.8%) in standard and 15/391 (3.8%) in the extended time window. Independent clinical outcomes (mRS ≤ 2) were not statistically different in early and late-treated patients both for thrombolysis (48% vs. 28.6%, <i>p</i> = 0.25) and thrombectomy (38.4% vs. 33.3%, <i>p</i> = 0.99). Even with a limited availability of advanced imaging extending therapeutic time windows resulted in an 11.7% increase in thrombolysis and a 44% increase in thrombectomy with comparable clinical outcomes in early and late-treated patients at the price of a twofold burden in clinical and advanced imaging screening.</p>

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Workload and clinical impact of MRI-based extension of reperfusion therapy time window in acute ischaemic stroke—a prospective single-centre study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月6日

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  • Tímea Tünde Takács,
  • Rita Magyar-Stang,
  • Szabolcs Szatmári,
  • Ildikó Sipos,
  • Katalin Saftics,
  • Ádám József Berki,
  • Sándor Évin,
  • Dániel Bereczki,
  • Csaba Varga,
  • Nóra Nyilas,
  • István Bíró,
  • Péter Barsi,
  • Máté Magyar,
  • Pál Maurovich-Horvat,
  • Péter Pál Böjti,
  • Máté Pásztor,
  • István Szikora,
  • Sándor Nardai,
  • Bence Gunda

摘要

Current European Stroke Organisation (ESO) guidelines recommend extended time window reperfusion therapies (4.5–9 h for thrombolysis, 6–24 h for thrombectomy) based on advanced imaging. However, the workload and clinical benefit of this strategy on a population basis are not known. To determine the caseload, treatment rates, and outcomes in the extended as compared to the standard time windows. All consecutive ischaemic stroke patients within 24 h of last known well between 1st March 2021 and 28th February 2022 were included in a prospective single-centre study. Treatment eligibility in the extended time windows or wake-up strokes recognized within 4 h was based on current ESO guideline criteria using MRI DWI-PWI or DWI-FLAIR mismatch. MRI was only available during working hours (8–20 h); otherwise, CT/CTA was used. Clinical outcome in treated patients was assessed at three months. Among the 777 admitted patients, 252 (32.4%) had MRI. The thrombolysis rate was 119/304 (39.1%) in standard and 14/231 (6.1%) in the extended time window. The thrombectomy rate was 34/386 (8.8%) in standard and 15/391 (3.8%) in the extended time window. Independent clinical outcomes (mRS ≤ 2) were not statistically different in early and late-treated patients both for thrombolysis (48% vs. 28.6%, p = 0.25) and thrombectomy (38.4% vs. 33.3%, p = 0.99). Even with a limited availability of advanced imaging extending therapeutic time windows resulted in an 11.7% increase in thrombolysis and a 44% increase in thrombectomy with comparable clinical outcomes in early and late-treated patients at the price of a twofold burden in clinical and advanced imaging screening.