| Title: |
Endovascular Therapy for Patients With Low NIHSS Scores and Large Vessel Occlusion in the 6- to 24-Hour Window: Analysis of the CLEAR Study. |
| Authors: |
Marto, J. P.; Qureshi, M.; Nagel, S.; Nogueira, R. G.; Henon, H.; Tomppo, L.; Ringleb, P. A.; Haussen, D. C.; Abdalkader, M.; Puetz, V.; Zaidat, O. O.; Demeestere, J.; Ramos, J. N.; Ribo, M.; Olive-Gadea, M.; Mohammaden, M. H.; Ortega-Gutierrez, S.; Sheth, S.; Yamagami, H.; Dusart, A.; Raymond, J.; Caparros, F.; Kaiser, D.; Tanaka, K.; Virtanen, P.; Puri, A. S.; Siegler, J. E.; Zaidi, S. F.; Jumaa, M. A.; Lin, E.; Requena, M.; Michel, P.; Winzer, S. M.; Klein, P.; Nannoni, S.; Bellante, F.; Salazar-Marioni, S.; Galecio-Castillo, M.; Wouters, A.; Ventura, R.; Mujanovic, A.; Shu, L.; Castonguay, A. C.; Jesser, J.; Masoud, H. E.; Kaesmacher, J.; Hu, W.; Roy, D.; Yaghi, S.; Asdaghi, N.; Strambo, D.; Lemmens, R.; Strbian, D.; Cordonnier, Charlotte; Möhlenbruch, M.; Nguyen, T. N. |
| Contributors: |
Centro Hospitalar Universitário Lisboa Central; Lille Neurosciences & Cognition - U 1172 (LilNCog); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Boston University Boston (BU) |
| Source: |
ISSN: 0028-3878. |
| Publisher Information: |
CCSD; American Academy of Neurology |
| Publication Year: |
2025 |
| Collection: |
LillOA (HAL Lille Open Archive, Université de Lille) |
| Subject Terms: |
[SDV]Life Sciences [q-bio] |
| Description: |
International audience ; Background and ObjectivesThere is uncertainty about whether patients with an anterior circulation large vessel occlusion (LVO) and a low NIH Stroke Scale (NIHSS) score (≤5) benefit from endovascular therapy (EVT) in the late time window (6–24 hours). We compared the clinical outcomes of these patients receiving EVT with those receiving medical management (MM).MethodsThe CT for Late Endovascular Reperfusion multinational cohort study was conducted at 66 sites across 10 countries from January 2014 to May 2022. This subanalysis included consecutive patients with late-window stroke due to an anterior circulation LVO, defined as occlusion of the internal carotid artery or proximal middle cerebral artery (M1/M2 segments), and a baseline NIHSS score ≤5 who received EVT or MM alone. The primary end point was a 90-day ordinal shift in the modified Rankin Scale (mRS) score. Secondary outcomes were 90-day excellent outcome (defined as mRS scores 0–1 or return to baseline mRS score in patients with a prestroke mRS score >1) and favorable outcome (defined as mRS scores 0–2 or return to baseline mRS score in patients with prestroke mRS score >2). Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. We used ordinal and binary logistic regression models to test for outcome differences.ResultsAmong 5,098 patients, 318 patients were included (median [interquartile range] age 67 [56–76] years; 149 [46.9%] were female; baseline NIHSS score was 4 [2–5]). A total of 202 patients (63.5%) received EVT and 116 MM (36.5%). There was no difference in favorable 90-day ordinal mRS score shift (adjusted common odds ratio [OR] 0.77, 95% CI 0.45–1.32), excellent outcome (adjusted OR 0.86, 95% CI 0.49–1.50), or favorable outcome (adjusted OR 0.72, 95% CI 0.35–1.50) in the EVT group compared with MM. Symptomatic intracranial hemorrhage risk (adjusted OR 3.40, 95% CI 0.84–13.73) and mortality at 90 days (adjusted OR 2.44, 95% CI 0.60–10.02) were not statistically different between treatment ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40112237; PUBMED: 40112237 |
| DOI: |
10.1212/WNL.0000000000213442 |
| Availability: |
https://hal.univ-lille.fr/hal-05303413; https://doi.org/10.1212/WNL.0000000000213442 |
| Accession Number: |
edsbas.72C8AC46 |
| Database: |
BASE |