PT -期刊文章盟- James e . Siegler AU -默罕默德·m·库雷希AU -劳尔•g . Nogueira盟Kanta田中盟的帕特里克•米歇尔-西蒙·内格尔盟盟-尼古拉斯警员盟Marc日博盟- Hiroshi Yamagami盟Shinichi Yoshimura AU -穆罕默德Abdalkader AU - c•迪奥戈Haussen盟马哈茂德·h·Mohammaden AU -普Nannoni AU -马库斯·a·Mohlenbruch盟(婆婆Henon AU -苏尼尔•a . Sheth盟-圣地亚哥Ortega-Gutierrez AU -玛尔塔Olive-Gadea AU -弗朗索瓦•Caparros AU - Fatih克朗AU -赛义德·扎伊迪盟- Alicia C. Castonguay AU - Kazutaka Uchida AU - Nobuyuki Sakai AU - Ajit S. Puri AU - Mudassir Farooqui AU - Kazunori Toyoda AU - Sergio Salazar-Marioni AU - Masataka Takeuchi AU - Behzad Farzin AU - Hesham E. Masoud AU - Anna Luisa Kuhn AU - Ameena Rana AU - Masafumi Morimoto AU - Masunari Shibata AU - Tadashi Nonaka AU - Piers Klein AU - Anvitha Sathya AU - Nicole L. Kiley AU - Charlotte Cordonnier AU - Davide Strambo AU - Jelle Demeestere AU - Peter A. Ringleb AU - Daniel Roy AU - Osama O. Zaidat AU - Tudor G. Jovin AU - Johannes Kaesmacher AU - Urs Fischer AU - Jean Raymond AU - Thanh N. Nguyen TI - Endovascular vs Medical Management for Late Anterior Large Vessel Occlusion With Prestroke Disability AID - 10.1212/WNL.0000000000201543 DP - 2023 Feb 14 TA - Neurology PG - e751--e763 VI - 100 IP - 7 4099 - //www.ebmtp.com/content/100/7/e751.short 4100 - //www.ebmtp.com/content/100/7/e751.full SO - Neurology2023 Feb 14; 100 AB - Background and Objectives Current guidelines do not address recommendations for mechanical thrombectomy (MT) in the extended time window (>6 hours after time last seen well [TLSW]) for large vessel occlusion (LVO) patients with preexisting modified Rankin Scale (mRS) > 1. In this study, we evaluated the outcomes of MT vs medical management in patients with prestroke disability presenting in the 6- to 24-hour time window with acute LVO.Methods We analyzed a multinational cohort (61 sites, 6 countries from 2014 to 2020) of patients with prestroke (or baseline) mRS 2 to 4 and anterior circulation LVO treated 6–24 hours from TLSW. Patients treated in the extended time window with MT vs medical management were compared using multivariable logistic regression and inverse probability of treatment weighting (IPTW). The primary outcome was the return of Rankin (ROR, return to prestroke mRS by 90 days).Results Of 554 included patients (448 who underwent MT), the median age was 82 years (interquartile range [IQR] 72–87) and the National Institutes of Health Stroke Scale (NIHSS) was 18 (IQR 13–22). In both MV logistic regression and IPTW analysis, MT was associated with higher odds of ROR (adjusted OR [aOR] 3.96, 95% CI 1.78–8.79 and OR 3.10, 95% CI 1.20–7.98, respectively). Among other factors, premorbid mRS 4 was associated with higher odds of ROR (aOR, 3.68, 95% CI 1.97–6.87), while increasing NIHSS (aOR 0.90, 95% CI 0.86–0.94) and decreasing Alberta Stroke Program Early Computed Tomography Scale score (aOR per point 0.86, 95% CI 0.75–0.99) were associated with lower odds of ROR. Age, intravenous thrombolysis, and occlusion location were not associated with ROR.Discussion In patients with preexisting disability presenting in the 6- to 24-hour time window, MT is associated with a higher probability of returning to baseline function compared with medical management.Classification of Evidence This investigation's results provide Class III evidence that in patients with preexisting disability presenting 6–24 hours from the TLSW and acute anterior LVO stroke, there may be a benefit of MT over medical management in returning to baseline function.ASPECTS=Alberta Stroke Program Early Computed Tomography Scale; CLEAR=CT for Late Endovascular Reperfusion; IPTW=inverse probability of treatment weighting; IQR=interquartile range; IVT=intravenous thrombolysis; LVO=large vessel occlusion; MCA=middle cerebral artery; mRS=modified Rankin Scale; MT=mechanical thrombectomy; MV=multivariable; NIHSS=National Institutes of Health Stroke Scale; PS=propensity score; RESCUE-Japan Registry 2=Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2; ROR=return of Rankin; SMR=standardized mortality ratio; TLSW=time last seen well; UW=utility weighted

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