Nguyen Trung Quoc, Nguyen Khang Vinh, Tran Hang Thi Minh, Pham Binh Nguyen, Truong Anh Le Tuan, Le Thien Quang, Duong Hai Quang, Nguyen Trung Thanh, Do Binh Thi Thanh, Nguyen Lanh Chi, Ha Duc Tan, Nguyen Tran Tran Ngoc, Bach Dung Tri, Nguyen Nhi Thanh, Tran Vu Thanh, Le Tra Vu Son, Do Huy Quoc, Nguyen Huong Thi Bich, Huynh Huy Quoc, Dang Huy Quang, Chiem Duc Nguyen, Pham Thai Nguyen Thanh, Doan Hanh Thi My, Hoang Dinh Chau Bao, Ngo Trinh Thi Kim, Dang Hung Minh, Phan Bang, Chen Yimin, Nguyen Thanh N, Nguyen Thang Ba, Nguyen Thang Huy
Department of Cerebrovascular Disease, 115 People's Hospital, Ho Chi Minh City, Vietnam.
University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Int J Stroke. 2025 Aug 8:17474930251367867. doi: 10.1177/17474930251367867.
Although the efficacy and safety of endovascular treatment (EVT) for large-core ischemic stroke have been proven, most trials used perfusion imaging or included early-window patients, limiting generalizability to the late window, particularly in developing countries.
We aimed to evaluate the safety and functional outcomes of EVT in large-core stroke patients treated between 12 and 24 h (late window) from last known well (LKW).
We conducted a prospective, multicenter observational study across four comprehensive stroke centers in Vietnam, enrolling consecutive patients who underwent EVT within 24 h of symptom onset between August 2023 and September 2024. Large core was defined by an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5 on non-contrast computerized tomography (NCCT) or diffusion-weighted magnetic resonance imaging (DWI-MRI). Patients who underwent EVT within 12-24 h after LKW were compared to those treated before 12 h (early window). Primary and safety outcomes were independent ambulation (90-day modified Rankin scale (mRS) = 0-3) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were 90-day mRS 0-2, ordinal mRS, successful reperfusion (modified Thrombolysis in Cerebral Infarction score ⩾2b, early neurological deterioration (END)), and 90-day mortality.
Of 1872 patients receiving EVT, 343 with large ischemic cores (median age = 64.0 years, 33.8% female) were included, with 103 (30.0%) treated in the 12- to 24-h window. Compared to early-window patients, late-window patients had lower rates of intravenous thrombolysis (2.9% vs. 32.9%, p < 0.001), higher brain MRI use (51.5% vs. 16.2%, p < 0.001), and longer pre-treatment imaging-to-groin puncture times (106 vs. 77 min, p < 0.001). After adjusting for confounders, there were no significant differences in 90-day mRS 0-3 (56.3% vs. 55.0%, adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.39-1.28, p = 0.26), ordinal mRS (aOR = 1.21, 95% CI = 0.78-1.90, p = 0.39), and sICH (aOR = 1.12, 95% CI = 0.32-3.50, p = 0.85). Other secondary outcomes were also similar.
In patients with anterior circulation large vessel occlusion stroke and low ASPECTS, EVT at 12-24 h versus <12 h from symptom onset showed no significant differences in clinical or safety outcomes. Larger trials are needed to confirm these findings, especially in developing regions.
尽管血管内治疗（EVT）对大梗死核心缺血性卒中的疗效和安全性已得到证实，但大多数试验使用了灌注成像或纳入了早期窗患者，限制了其对晚期窗的普遍适用性，尤其是在发展中国家。
我们旨在评估在最后已知正常（LKW）后12至24小时（晚期窗）接受治疗的大梗死核心卒中患者中EVT的安全性和功能结局。
我们在越南的四个综合卒中中心进行了一项前瞻性、多中心观察性研究，纳入了2023年8月至2024年9月期间症状发作后24小时内接受EVT的连续患者。大梗死核心由非增强计算机断层扫描（NCCT）或扩散加权磁共振成像（DWI-MRI）上的阿尔伯塔卒中项目早期CT评分（ASPECTS）为3至5定义。将在LKW后12至24小时接受EVT的患者与在12小时之前（早期窗）接受治疗的患者进行比较。主要和安全性结局为独立行走（90天改良Rankin量表（mRS）=0至3）和症状性颅内出血（sICH）。次要结局为90天mRS 0至2、序数mRS、成功再灌注（改良脑梗死溶栓评分⩾2b）、早期神经功能恶化（END）和90天死亡率。
在1872例接受EVT的患者中，纳入了343例大缺血性梗死核心患者（中位年龄=64.0岁，33.8%为女性），其中103例（30.0%）在12至24小时窗内接受治疗。与早期窗患者相比，晚期窗患者静脉溶栓率较低（2.9%对32.9%，p<0.001），脑MRI使用率较高（51.5%对16.2%，p<0.001），治疗前成像至腹股沟穿刺时间较长（106对77分钟，p<0.001）。在调整混杂因素后，90天mRS 0至3（56.3%对55.0%，调整优势比（aOR）=0.71，95%置信区间（CI）=0.39至1.28，p=0.26）、序数mRS（aOR=1.21，95%CI=0.78至1.90，p=0.39）和sICH（aOR=
