@article {Dekkersvn-2020-000803, author = {Luuk Dekker and Esmee Venema and F Anne V Pirson and Charles B L M Majoie and Bart J Emmer and Ivo G H Jansen and Maxim J H L Mulder and Robin Lemmens and Robert-Jan B Goldhoorn and Marieke J H Wermer and Jelis Boiten and Geert J Lycklama {\`a} Nijeholt and Yvo B W E M Roos and Adriaan C G M van Es and Hester F Lingsma and Diederik W J Dippel and Wim H van Zwam and Robert J van Oostenbrugge and Ido R van den Wijngaard}, editor = {, and , and Vos, Jan Albert and Compagne, Kars C J and Kappelhof, Manon and Brouwer, Josje and den Hartog, Sanne J and Hinsenveld, Wouter H and Roozenbeek, Bob and Coutinho, Jonathan M and van Walderveen, Marianne A A and Staals, Julie and Hofmeijer, Jeannette and Martens, Jasper M and de Bruijnl, Sebastiaan F and Lukas, C and van Dijk, H and Worp, Bart van der and Lo, Rob H and van Dijk, Ewoud J and Hieronymus, D Boogaarts and de Vries, J and de Kort, Paul L M and Tuijl, Julia van and Peluso, Jo P and Fransen, Puck and van den Berg, Jan S P and van Hasselt, Boudewijn A A M and Aerden, Leo A M and Dallinga, Ren{\'e} J and Uyttenboogaart, Maarten and Eschgi, Omid and Bokkers, Reinoud P H and Schreuder, Tobien H C M L and Heijboer, Roel J J and Keizer, Koos and Yo, Lonneke S F and den Hertog, Heleen M and Sturm, Emiel J C and Brouwers, Paul J A M and Sprengers, Marieke E S and Jenniskens, Sjoerd F M and Berg, Ren{\'e} van den and Yoo, Albert J and Beenen, Ludo F M and Postma, Alida A and Roosendaal, Stefan D and van der Kallen, Bas F W and van den Wijngaard, Ido R and van Es, Adriaan C G M and Bot, Joost and Doormaal, Pieter-Jan van and Meijer, Anton and Ghariq, Elyas and Marc, P and van Proosdij;, G and Krietemeijer, Menno and Gerrits, Dick and Dinkelaar, Wouter and Appelman, Auke P A and Hammer, Bas and Pegge, Sjoert and Hoorn, Anouk van der and Vinke, Saman and Schonewille, Wouter J and Ghannouti, Naziha el and Sterrenberg, Martin and Pellikaan, Wilma and Sprengers, Rita and Elfrink, Marjan and Simons, Michelle and Vossers, Marjolein and Meris, Joke de and Vermeulen, Tamara and Geerlings, Annet and Vemde, Gina van and Simons, Tiny and Messchendorp, Gert and Nicolaij, Nynke and Bongenaar, Hester and Bodde, Karin and Kleijn, Sandra and Lodico, Jasmijn and Droste, Hanneke and Wollaert, Maureen and Verheesen, Sabrina and Jeurrissen, D and Bos, Erna and Drabbe, Yvonne and Sandiman, Michelle and Aaldering, Nicoline and Zweedijk, Berber and Vervoort, Jocova and Ponjee, Eva and Romviel, Sharon and Harmsma, Roger R M and Muijres, Daan and Berkhemer, Olvert A and Boers, M M Anna and Huguet, J and Groot, P F C and Mens, Marieke A and van Kranendonk, Katinka R and Treurniet, Kilian M and Tolhuisen, Manon L and Alves, Heitor and Weterings, Annick J and Kirkels, Eleonora L F and Voogd, Eva J H F and Schupp, Lieve M and Collette, Sabine and Groot, Adrien E D and LeCouffe, Natalie E and Konduri, Praneeta R and Prasetya, Haryadi and Arrarte-Terreros, Nerea and Ramos, Lucas A}, title = {Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry}, elocation-id = {svn-2020-000803}, year = {2021}, doi = {10.1136/svn-2020-000803}, publisher = {BMJ Specialist Journals}, abstract = {Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0{\textendash}2), and death.Results Of 3264 patients who underwent EVT, 106 (3.2\%) were treated beyond 6.5 hours (median 8.5, IQR 6.9{\textendash}10.6), of whom 93 (87.7\%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2\%) late window patients. Late window patients were younger (mean 67 vs 70 years, p\<0.04) and had slightly lower ASPECTS (median 8 vs 9, p\<0.01), but better collateral status (collateral score 2{\textendash}3: 68.3\% vs 57.7\%, p=0.03). No differences were observed in proportions of functional independence (43.3\% vs 40.5\%, p=0.57) or death (24.0\% vs 28.9\%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95\% CI 0.56 to 1.93).Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5{\textendash}24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.Individual patient data cannot be made available, because no patient approval has been obtained for sharing data, even in coded form. However, syntax and output files of statistical analyses can be made available upon reasonable request.}, issn = {2059-8688}, URL = {https://svn.bmj.com/content/early/2021/04/06/svn-2020-000803}, eprint = {https://svn.bmj.com/content/early/2021/04/06/svn-2020-000803.full.pdf}, journal = {Stroke and Vascular Neurology} }