Late Thrombectomy in Clinical Practice Retrospective Application of DAWN/DEFUSE3 Criteria within the German Stroke Registry

• Published in: Clinical neuroradiology (Munich) Vol. 31; no. 3; pp. 799 - 810
• Main Authors: Herzberg, Moriz, Scherling, Korbinian, Stahl, Robert, Tiedt, Steffen, Wollenweber, Frank A., Küpper, Clemens, Feil, Katharina, Forbrig, Robert, Patzig, Maximilian, Kellert, Lars, Kunz, Wolfgang G., Reidler, Paul, Zimmermann, Hanna, Liebig, Thomas, Dieterich, Marianne, Dorn, Franziska
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2021
• Subjects: Brain Ischemia; Humans; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosurgery; Original; Original Article; Registries; Retrospective Studies; Stroke - diagnostic imaging; Stroke - therapy; Thrombectomy; Treatment Outcome; Stroke; Endovascular therapy; Late thrombectomy; Outcome
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-021-01033-1

Background and Purpose
To provide real-world data on outcome and procedural factors of late thrombectomy patients.
Methods
We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS 
≤
 2).
Results
Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6–24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%;
n
 = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (
p
 = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes.
Conclusion
In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6–24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.