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Collateral status affects the onset-to-reperfusion time window for good outcome

Authors
 Byung Moon Kim  ;  Jang-Hyun Baek  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Joonsang Yoo  ;  Dong Joon Kim  ;  Pyoung Jeon  ;  Seung Kug Baik  ;  Sang Hyun Suh  ;  Kyung Yol Lee  ;  Hyo Sung Kwak  ;  Hong Gee Roh  ;  Young-Jun Lee  ;  Sang Heum Kim  ;  Chang-Woo Ryu  ;  Yon-Kwon Ihn  ;  Byungjoon Kim  ;  Hong Jun Jeon  ;  Jin Woo Kim  ;  Jun Soo Byun  ;  Sangil Suh  ;  Jeong Jin Park  ;  Woong Jae Lee  ;  Jieun Roh  ;  Byoung-Soo Shin  ;  Oh Young Bang 
Citation
 Journal of Neurology, Neurosurgery and Psychiatry, Vol.89(9) : 903-909, 2018 
Journal Title
 Journal of Neurology, Neurosurgery and Psychiatry 
ISSN
 0022-3050 
Issue Date
2018
Abstract
OBJECTIVE: To characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on collateral status. METHODS: This was a retrospective analysis of clinical and imaging data of 554 consecutive patients, who had recanalisation success by EVT for anterior circulation large artery occlusion, from the prospectively maintained registries of 16 comprehensive stroke centres between September 2010 and December 2015. The patients were dichotomised into good and poor collateral groups, based on CT angiography. We tested whether the likelihood of good outcome (modified Rankin Scale, 0-2) by ORT was different between two groups. RESULTS: ORT was 298 min±113 min (range, 81-665 min), and 84.5% of patients had good collaterals. Age, diabetes mellitus, previous infarction, National Institutes of Health Stroke Scale, good collaterals (OR 40.766; 95% CI 10.668 to 155.78; p<0.001) and ORT (OR 0.926 every 30 min delay; 95% CI 0.862 to 0.995; p=0.037) were independently associated with good outcome. The drop in likelihood of good outcome associated with longer ORT was significantly faster in poor collateral group (OR 0.305 for every 30 min; 95% CI 0.113 to 0.822) than in good collateral group (OR 0.926 for every 30 min; 95% CI 0.875 to 0.980). CONCLUSIONS: Earlier successful recanalisation was strongly associated with good outcome in poor collateral group; however, this association was weak during the tested time window in good collateral group. This suggests that the ORT window for good outcome can be adjusted according to collateral status.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163440
DOI
10.1136/jnnp-2017-317627
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
Yonsei Authors
김동준(Kim, Dong Joon) ORCID logo https://orcid.org/0000-0002-7035-087X
김병문(Kim, Byung Moon) ORCID logo https://orcid.org/0000-0001-8593-6841
김영대(Kim, Young Dae)
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
서상현(Suh, Sang Hyun) ORCID logo https://orcid.org/0000-0002-7098-4901
이경열(Lee, Kyung Yul) ORCID logo https://orcid.org/0000-0001-5585-7739
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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