Pham Binh Nguyen, Tran Hang T Minh, Nguyen An Thai Thanh, Pham Huan Nguyen, Truong Anh Tuan Le, Nguyen Trung Quoc, Nguyen Huong Bich Thi, Nguyen Tri Quang, Do Huy Quoc, Le Tra Vu Son, Tran Vu Thanh, Nguyen Ryan Anh-Quang, Nguyen Huy, Nguyen Thang Ba, Nguyen Thang Huy
Department of Cerebrovascular Disease, People's Hospital 115, Ho Chi Minh City, Vietnam.
Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
Cerebrovasc Dis Extra. 2025;15(1):9-18. doi: 10.1159/000542653. Epub 2024 Nov 19.
Recent trials have demonstrated the remarkable benefit of endovascular treatment (EVT) up to 24 h in patients with large vessel occlusion (LVO) and target mismatch profiles; however, benefits of late-window EVT in Vietnamese population remain poorly understood. This study aims to evaluate the real-world outcomes of EVT in acute ischemic stroke (AIS) patients selected using perfusion imaging within the 6-24-h window.
This is a prospective study of consecutive patients with anterior circulation LVO stroke who underwent EVT within 6-24 h after last known well between August 2022 and March 2024. Patients were selected based on the DAWN/DEFUSE-3 criteria (Perfusion-RAPID, iSchemaView). The primary outcome was the proportion of patients with functional independence at 90 days (modified Rankin Scale score of 0-2). The secondary outcomes were successful reperfusion defined by thrombolysis in cerebral infarction (TICI) ≥2b on the final procedure and subgroup analysis between good (hypoperfusion intensity ratio [HIR] <0.4) and poor collaterals (HIR ≥0.4) groups. Safety outcomes were mortality rate and symptomatic intracranial hemorrhage (sICH).
Of 122 enrolled patients, 68% met inclusion criteria of DEFUSE-3 trial, 61% met DAWN trial criteria. Mean age was 66 years, median baseline NIHSS was 13, median time from stroke onset to hospital arrival was 12.55 h (9.50-16.48), and median infarct volume was 11.5 mL. The rate of functional independence at 90 days was 45.9%. Successful reperfusion (TICI score of ≥2b) was achieved by 83.6% of cases. The 90-day mortality rate was 10.7%; sICH was reported in 8 patients (6.6%). Patients with good collaterals had better functional outcome.
This real-world observational study suggests that late-window EVT may be safe and effective in eligible Vietnamese patients selected based on perfusion imaging, thus supporting its practical use in this patient population. HIR is a robust indicator of collateral status and could made it a valuable addition to stroke imaging workup in clinical setting.
近期试验表明，对于大血管闭塞（LVO）且存在目标不匹配特征的患者，血管内治疗（EVT）在24小时内具有显著益处；然而，越南人群中晚期窗EVT的益处仍知之甚少。本研究旨在评估在6至24小时窗内使用灌注成像选择的急性缺血性卒中（AIS）患者进行EVT的真实世界结局。
这是一项对2022年8月至2024年3月期间在最后一次已知健康状态后6至24小时内接受EVT的前循环LVO卒中连续患者的前瞻性研究。患者根据DAWN/DEFUSE-3标准（Perfusion-RAPID，iSchemaView）进行选择。主要结局是90天时功能独立患者的比例（改良Rankin量表评分为0至2）。次要结局是最终手术时脑梗死溶栓（TICI）≥2b定义的成功再灌注以及良好（低灌注强度比[HIR]<0.4）和不良侧支循环（HIR≥0.4）组之间的亚组分析。安全性结局是死亡率和症状性颅内出血（sICH）。
122例入组患者中，68%符合DEFUSE-3试验的纳入标准，61%符合DAWN试验标准。平均年龄为66岁，基线NIHSS中位数为13，从中风发作到入院的中位时间为12.55小时（9.50 - 16.48），梗死体积中位数为11.5 mL。90天时功能独立率为45.9%。83.6%的病例实现了成功再灌注（TICI评分≥2b）。90天死亡率为10.7%；8例患者（6.6%）报告发生sICH。侧支循环良好的患者功能结局更好。
这项真实世界观察性研究表明，对于基于灌注成像选择的符合条件的越南患者，晚期窗EVT可能是安全有效的，从而支持其在该患者群体中的实际应用。HIR是侧支循环状态的有力指标，可使其成为临床环境中卒中影像学检查的有价值补充。
