Stroke: Stroke patients, the core infarct area increases rapidly, and they benefit more from endovascular treatment

For patients with acute ischemic stroke with large vessel occlusion , endovascular thrombectomy (EVT) has become the standard treatment method.
Several clinical trials published in 2015 showed that for patients within 6 hours of the onset of stroke, EVT is better than simple Intravenous thrombolysis (IVT) .

Vascular Stroke Thrombosis

Subsequently, two more trials proved the benefits of EVT for patients who appeared within 6 hours to 24 hours, namely DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) test
.

However, the absolute therapeutic effect of EVT varies greatly in different trials, and the greater therapeutic effect in some trials has been attributed to the choice of perfusion imaging
.

Of particular relevance is that in the two late window trials (both using perfusion imaging options), the therapeutic effect of EVT was greater than that of the early window trial

This is called the late window paradox by Albers.

Therefore, Albers' hypothesis is limited to EVT and no-reperfusion therapy
.

In this way, Longting Lin and others of Shanghai East China Hospital extended the hypothesis to EVT and IVT treatments
.

By using the world's largest acute stroke perfusion imaging data set to date, it aims to test how the benefits of EVT and IVT are changed by core growth rates

This retrospective cohort study identified patients with acute ischemic stroke with large vessel occlusion and received reperfusion therapy, namely EVT or intravenous thrombolysis (IVT) within 4.
5 hours after the stroke
.

The patients were divided into 2 groups

The main clinical outcome is a good outcome, defined as a 3-month modified Rankin scale score of 0-2

They included a total of 806 patients, 429 in the EVT group (recanalization rate 61.
6%), and only 377 in the IVT group (recanalization rate 44.
7%)
.

The therapeutic effect of EVT and IVT only is mediated by core growth rate, showing that EVT treatment and core growth rate are predicting good clinical outcomes (interaction probability=1.

For patients with a core growth rate> 25 mL/h, EVT treatment (compared to IVT only) increased the chance of a good clinical outcome (adjusted odds ratio=3.
62[1.
21-10.
76], P=0.
021), and resulted in higher Small final infarct volume (37.
5 and 73.
9 mL, P=0.
012)
.

For patients with slow core growth <15 mL/h, the EVT group and the IVT group only have good clinical results (adjusted probability=1.
44[0.
97-2.
14], P=0.
070) or final infarct volume (22.
6 vs.
21.
9 mL, P=0.
551) there was no significant difference
.

Conclusion: In the early time window of <4.
5 hours, rapid core growth has greater benefits than EVT and IVT
.

In the early time window of <4.
5 hours, rapid core growth has greater benefits compared to EVT and IVT
.

Original source:
Lin L, Zhang H, Chen C, et al.

Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy.
Stroke.

Stroke Patients With Faster Core Growth Have Greater Benefit From Endovascular Therapy.
Stroke.

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