Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study

James E Siegler; Steven R Messé; Heidi Sucharew; Scott E Kasner; Tapan Mehta; Niraj Arora; Amy K Starosciak; Felipe De Los Rios La Rosa; Natasha R Barnhill; Akshitkumar M Mistry; Kishan Patel; Salman Assad; Amjad Tarboosh; Katarina Dakay; Sanjana Salwi; Jeff Wagner; Alicia Bennett; Bharathi D Jagadeesan; Christopher Streib; Stewart A Weber; Rohan Chitale; John J Volpi; Stephan A Mayer; Shadi Yaghi; Mahesh Jayaraman; Pooja Khatri; Eva A Mistry

Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study

James E Siegler, Steven R Messé, Heidi Sucharew, Scott E Kasner, Tapan Mehta, Niraj Arora, Amy K Starosciak, Felipe De Los Rios La Rosa, Natasha R Barnhill, Akshitkumar M Mistry, Kishan Patel, Salman Assad, Amjad Tarboosh, Katarina Dakay, Sanjana Salwi, Jeff Wagner, Alicia Bennett, Bharathi D Jagadeesan, Christopher Streib, Stewart A WeberRohan Chitale, John J Volpi, Stephan A Mayer, Shadi Yaghi, Mahesh Jayaraman, Pooja Khatri, Eva A Mistry

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Because of the overwhelming benefit of thrombectomy for highly selected trial patients with large vessel occlusion (LVO), some trial-ineligible patients are being treated in practice.

OBJECTIVE: To determine the safety and efficacy of thrombectomy in DAWN/DEFUSE-3-ineligible patients.

METHODS: Using a multicenter prospective observational study of consecutive patients with anterior circulation LVO who underwent late thrombectomy, we compared symptomatic intracerebral hemorrhage (sICH) and good outcome (90-d mRS 0-2) among DAWN/DEFUSE-3-ineligible patients to trial-eligible patients and to untreated DAWN/DEFUSE-3 controls.

RESULTS: Ninety-eight patients had perfusion imaging and underwent thrombectomy >6 h; 46 (47%) were trial ineligible (41% M2 occlusions, 39% mild deficits, 28% ASPECTS <6 had poorer outcomes (aOR 0.14, 95% CI 0.05-0.44) and more sICH (aOR 24, 95% CI 5.7-103). Compared to untreated DAWN/DEFUSE-3 controls, trial-ineligible patients had more sICH (13%BEST vs 3%DAWN [P = .02] vs 4%DEFUSE [P = .05]), but were more likely to achieve a good outcome at 90 d (36%BEST vs 13%DAWN [P < .01] vs 17%DEFUSE [P = .01]).

CONCLUSION: Thrombectomy is used in practice for some patients ineligible for the DAWN/DEFUSE-3 trials with potentially favorable outcomes. Additional trials are needed to confirm the safety and efficacy of thrombectomy in broader populations, such as large core infarction and M2 occlusions.

Original language	American English
Journal	Neurosurgery
State	Published - Nov 23 2019

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Siegler, J. E., Messé, S. R., Sucharew, H., Kasner, S. E., Mehta, T., Arora, N., Starosciak, A. K., De Los Rios La Rosa, F., Barnhill, N. R., Mistry, A. M., Patel, K., Assad, S., Tarboosh, A., Dakay, K., Salwi, S., Wagner, J., Bennett, A., Jagadeesan, B. D., Streib, C., ... Mistry, E. A. (2019). Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study. Neurosurgery. http://sfxhosted.exlibrisgroup.com/hfhs?sid=Entrez:PubMed&id=pmid:31758197

Siegler, JE, Messé, SR, Sucharew, H, Kasner, SE, Mehta, T, Arora, N, Starosciak, AK, De Los Rios La Rosa, F, Barnhill, NR, Mistry, AM, Patel, K, Assad, S, Tarboosh, A, Dakay, K, Salwi, S, Wagner, J, Bennett, A, Jagadeesan, BD, Streib, C, Weber, SA, Chitale, R, Volpi, JJ, Mayer, SA, Yaghi, S, Jayaraman, M, Khatri, P & Mistry, EA 2019, 'Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study', Neurosurgery. <http://sfxhosted.exlibrisgroup.com/hfhs?sid=Entrez:PubMed&id=pmid:31758197>

@article{ba5f539d4fca4c9e8d1c104efd0501d4,

title = "Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study",

abstract = " BACKGROUND: Because of the overwhelming benefit of thrombectomy for highly selected trial patients with large vessel occlusion (LVO), some trial-ineligible patients are being treated in practice. OBJECTIVE: To determine the safety and efficacy of thrombectomy in DAWN/DEFUSE-3-ineligible patients. METHODS: Using a multicenter prospective observational study of consecutive patients with anterior circulation LVO who underwent late thrombectomy, we compared symptomatic intracerebral hemorrhage (sICH) and good outcome (90-d mRS 0-2) among DAWN/DEFUSE-3-ineligible patients to trial-eligible patients and to untreated DAWN/DEFUSE-3 controls. RESULTS: Ninety-eight patients had perfusion imaging and underwent thrombectomy >6 h; 46 (47%) were trial ineligible (41% M2 occlusions, 39% mild deficits, 28% ASPECTS <6 had poorer outcomes (aOR 0.14, 95% CI 0.05-0.44) and more sICH (aOR 24, 95% CI 5.7-103). Compared to untreated DAWN/DEFUSE-3 controls, trial-ineligible patients had more sICH (13%BEST vs 3%DAWN [P = .02] vs 4%DEFUSE [P = .05]), but were more likely to achieve a good outcome at 90 d (36%BEST vs 13%DAWN [P < .01] vs 17%DEFUSE [P = .01]). CONCLUSION: Thrombectomy is used in practice for some patients ineligible for the DAWN/DEFUSE-3 trials with potentially favorable outcomes. Additional trials are needed to confirm the safety and efficacy of thrombectomy in broader populations, such as large core infarction and M2 occlusions.",

author = "Siegler, {James E} and Mess{\'e}, {Steven R} and Heidi Sucharew and Kasner, {Scott E} and Tapan Mehta and Niraj Arora and Starosciak, {Amy K} and {De Los Rios La Rosa}, Felipe and Barnhill, {Natasha R} and Mistry, {Akshitkumar M} and Kishan Patel and Salman Assad and Amjad Tarboosh and Katarina Dakay and Sanjana Salwi and Jeff Wagner and Alicia Bennett and Jagadeesan, {Bharathi D} and Christopher Streib and Weber, {Stewart A} and Rohan Chitale and Volpi, {John J} and Mayer, {Stephan A} and Shadi Yaghi and Mahesh Jayaraman and Pooja Khatri and Mistry, {Eva A}",

note = "Siegler JE, Messe SR, Sucharew H, Kasner SE, Mehta T, Arora N, Starosciak AK, De Los Rios La Rosa F, Barnhill NR, Mistry AM, Patel K, Assad S, Tarboosh A, Dakay K, Salwi S, Wagner J, Bennett A, Jagadeesan BD, Streib C, Weber SA, Chitale R, Volpi JJ, Mayer SA, Yaghi S, Jayaraman M, Khatri P, and Mistry EA. Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study. Neurosurgery 2019.",

year = "2019",

month = nov,

day = "23",

language = "American English",

journal = "Neurosurgery",

}

TY - JOUR

T1 - Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study

AU - Siegler, James E

AU - Messé, Steven R

AU - Sucharew, Heidi

AU - Kasner, Scott E

AU - Mehta, Tapan

AU - Arora, Niraj

AU - Starosciak, Amy K

AU - De Los Rios La Rosa, Felipe

AU - Barnhill, Natasha R

AU - Mistry, Akshitkumar M

AU - Patel, Kishan

AU - Assad, Salman

AU - Tarboosh, Amjad

AU - Dakay, Katarina

AU - Salwi, Sanjana

AU - Wagner, Jeff

AU - Bennett, Alicia

AU - Jagadeesan, Bharathi D

AU - Streib, Christopher

AU - Weber, Stewart A

AU - Chitale, Rohan

AU - Volpi, John J

AU - Mayer, Stephan A

AU - Yaghi, Shadi

AU - Jayaraman, Mahesh

AU - Khatri, Pooja

AU - Mistry, Eva A

N1 - Siegler JE, Messe SR, Sucharew H, Kasner SE, Mehta T, Arora N, Starosciak AK, De Los Rios La Rosa F, Barnhill NR, Mistry AM, Patel K, Assad S, Tarboosh A, Dakay K, Salwi S, Wagner J, Bennett A, Jagadeesan BD, Streib C, Weber SA, Chitale R, Volpi JJ, Mayer SA, Yaghi S, Jayaraman M, Khatri P, and Mistry EA. Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study. Neurosurgery 2019.

PY - 2019/11/23

Y1 - 2019/11/23

N2 - BACKGROUND: Because of the overwhelming benefit of thrombectomy for highly selected trial patients with large vessel occlusion (LVO), some trial-ineligible patients are being treated in practice. OBJECTIVE: To determine the safety and efficacy of thrombectomy in DAWN/DEFUSE-3-ineligible patients. METHODS: Using a multicenter prospective observational study of consecutive patients with anterior circulation LVO who underwent late thrombectomy, we compared symptomatic intracerebral hemorrhage (sICH) and good outcome (90-d mRS 0-2) among DAWN/DEFUSE-3-ineligible patients to trial-eligible patients and to untreated DAWN/DEFUSE-3 controls. RESULTS: Ninety-eight patients had perfusion imaging and underwent thrombectomy >6 h; 46 (47%) were trial ineligible (41% M2 occlusions, 39% mild deficits, 28% ASPECTS <6 had poorer outcomes (aOR 0.14, 95% CI 0.05-0.44) and more sICH (aOR 24, 95% CI 5.7-103). Compared to untreated DAWN/DEFUSE-3 controls, trial-ineligible patients had more sICH (13%BEST vs 3%DAWN [P = .02] vs 4%DEFUSE [P = .05]), but were more likely to achieve a good outcome at 90 d (36%BEST vs 13%DAWN [P < .01] vs 17%DEFUSE [P = .01]). CONCLUSION: Thrombectomy is used in practice for some patients ineligible for the DAWN/DEFUSE-3 trials with potentially favorable outcomes. Additional trials are needed to confirm the safety and efficacy of thrombectomy in broader populations, such as large core infarction and M2 occlusions.

AB - BACKGROUND: Because of the overwhelming benefit of thrombectomy for highly selected trial patients with large vessel occlusion (LVO), some trial-ineligible patients are being treated in practice. OBJECTIVE: To determine the safety and efficacy of thrombectomy in DAWN/DEFUSE-3-ineligible patients. METHODS: Using a multicenter prospective observational study of consecutive patients with anterior circulation LVO who underwent late thrombectomy, we compared symptomatic intracerebral hemorrhage (sICH) and good outcome (90-d mRS 0-2) among DAWN/DEFUSE-3-ineligible patients to trial-eligible patients and to untreated DAWN/DEFUSE-3 controls. RESULTS: Ninety-eight patients had perfusion imaging and underwent thrombectomy >6 h; 46 (47%) were trial ineligible (41% M2 occlusions, 39% mild deficits, 28% ASPECTS <6 had poorer outcomes (aOR 0.14, 95% CI 0.05-0.44) and more sICH (aOR 24, 95% CI 5.7-103). Compared to untreated DAWN/DEFUSE-3 controls, trial-ineligible patients had more sICH (13%BEST vs 3%DAWN [P = .02] vs 4%DEFUSE [P = .05]), but were more likely to achieve a good outcome at 90 d (36%BEST vs 13%DAWN [P < .01] vs 17%DEFUSE [P = .01]). CONCLUSION: Thrombectomy is used in practice for some patients ineligible for the DAWN/DEFUSE-3 trials with potentially favorable outcomes. Additional trials are needed to confirm the safety and efficacy of thrombectomy in broader populations, such as large core infarction and M2 occlusions.

UR - https://scholarlycommons.henryford.com/neurology_articles/403

UR - http://sfxhosted.exlibrisgroup.com/hfhs?sid=Entrez:PubMed&id=pmid:31758197

M3 - Article

JO - Neurosurgery

JF - Neurosurgery

ER -

Thrombectomy in DAWN- and DEFUSE-3-Ineligible Patients: A Subgroup Analysis From the BEST Prospective Cohort Study

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