title: Safety of endovascular treatment beyond the 6-h time window in 205 patients.
abstract: OBJECTIVE
  Intra-arterial treatment (IAT) is effective when performed within 6 h of symptom onset in selected stroke patients ('T < 6H'). Its safety and efficacy is unclear when the patient has had symptoms for more than 6 h ('T > 6H') or for an unknown time (unclear-onset stroke, UOS), or woke up with a stroke (wake-up stroke, WUS). In this study we compared the safety of IAT in these four patient groups.
  
  
  METHODS
  Eight-hundred and fifty-nine patients treated with IAT were enrolled. The main outcome parameters were clinical outcome [excellent: modified Rankin Scale (mRS) 0 or 1; or favorable: mRS 0-2] or mortality 3 months after treatment. Further outcome parameters were the rates of vessel recanalization, and cerebral and systemic hemorrhage.
  
  
  RESULTS
  Six-hundred and fifty-four patients were treated before (T < 6H) and 205 after 6 h or an unknown time (128 T > 6H, 55 WUS and 22 UOS). NIHSS scores were higher in UOS patients than in T < 6H patients, vertebrobasilar occlusion was more common in T > 6H and UOS patients, and middle cerebral artery occlusions less common in T > 6H than in T < 6H patients. Other baseline characteristics were similar. There was no significant difference in clinical outcome and the rate of hemorrhage in multivariable regression analysis.
  
  
  CONCLUSIONS
  Clinical outcome of our four groups of patients was similar with no increase of hemorrhage rates in patients treated after awakening, after an unknown time or more than 6 h. Our preliminary data suggest that treatment of such patients may be performed safely. If confirmed in randomized trials, this would have major clinical implications.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Berne, Berne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Jung
authors.forename: J
authors.initials: J
authors.lastname: Gralla
authors.forename: U
authors.initials: U
authors.lastname: Fischer
authors.forename: M-L
authors.initials: ML
authors.lastname: Mono
authors.forename: A
authors.initials: A
authors.lastname: Weck
authors.forename: R
authors.initials: R
authors.lastname: Lüdi
authors.forename: M R
authors.initials: MR
authors.lastname: Heldner
authors.forename: O
authors.initials: O
authors.lastname: Findling
authors.forename: M
authors.initials: M
authors.lastname: El-Koussy
authors.forename: C
authors.initials: C
authors.lastname: Brekenfeld
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
authors.forename: M
authors.initials: M
authors.lastname: Arnold
mesh_terms: D000368:Aged; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014568:Urokinase-Type Plasminogen Activator