Safety Of Endovascular Therapy After 6 Hours Of Acute Ischemic Stroke Onset In Patients With Anterior Circulation Progressive Infarction

Objective: Endovascular therapy is effective in acute ischemic stroke within 6 hours result of acute intracranial artery occlusion.However,the safety and efficacy in patients with progressive ischemic stroke after 6 hours remains unclear.This study aims to analyze the safety and feasibility of endovascular intervention in patients with progressive ischemic stroke over 6 hours time window.Methods: A cohort of consecutive patients treated with endovascular recanalization resulting of intracerebral large vessel occlusions in anterior circulation were identifed by database review,between March 2015 and December 2016 in our stroke center.Patients were divided into two groups: test group in 6 hours and control group after 6 hours.Patients after 6 hours time window were selected for endovascular therapy by multi-model MR imagine regardless of stroke duration.Inclusion criteria:1)The symptoms were present between 6 hs and 72 hs.2)The symptoms were progressive,the NIHSS score increased by 4 points,and the preoperative NIHSS score was no less than 8 points.3)It was confirmed large vessel occlusion in anterior circulation by MRA.4)The infarction foci showed scattered in the watershed or the largest infarct territory was less than 70 ml on DWI.5)The number of microbleed was less than 5 on SWI.6)One of the following conditions must be satisfied: perfusion mismatch of DWI-FLAIR,prominence of ipsilateral medullary veins on SWI,ischemic area mismatch of ASL-DWI.The ary outcome was good functional outcome at 90 days,which was defined as a modified Rankin Scale score no more than 2.The safetyprim outcome was the rate of symptomatic intracranial hemorrhage and the mortality at 90 days.Results: 180 patients were included,One-hundred and forty-eight patients were treated in 6 hours time window,while 32 surpass 6hours.Compared to control group,patients in test group were younger(P=0.003)and less severer neurological deficit(13.9±3.7 VS 17.2±3.9,P<0.001),the mean symptom onset-to-puncture time was longer(1562.0±1288.4 minutes versus 205.2±112.4minutes,P<0.001),no significant difference of recanalization effectiveness was oberseved in these two groups(100% vs 89.9%,P=0.126),good functional outcome was more common(87.5% vs.58.1%,P=0.002),while there was no difference in symptomatic intracerebral hemorrhage rate and 90-days mortality.Conclusions: Our study sheds light on the safety and feasibility of endovascular therapy for patients presenting after 6 hours of stroke symptom onset resulting of anterior circulation cerebral artery occlusions by appropriately selected.If confirmed in randomized trials,this would have major clinical implications.