Data Do Not Support Selection of Patients for Stroke Treatment Within the 16- to 24-Hour Interval —Reply

In Reply We thank Powers for his comments regarding our article. He raises the question if the positive result for patients with target perfusion-imaging mismatch in the 12.8- to 24-hour tercile in the Analysis of Pooled Data From Randomized Studies of Thrombectomy More Than 6 Hours After Last Well Known (AURORA) study could solely be due to a benefit from 12.8 to 16 hours since last known well subgroup, with neutral or negative effects in the 16- to 24-hour time period. This was not the case. Data for patients in the 16- to 24-hour group with the target mismatch profile demonstrated an odds ratio of 3.82 (95% CI, 1.07-13.69; P = .04) for the primary end point. As described in the article, there was a high degree of overlap between the target and clinical mismatch profiles, and among the 76 patients who had target mismatch but did not meet the clinical mismatch criteria, there was no heterogeneity of the treatment effect compared with the patients who had clinical mismatch. Furthermore, the 2 reasons why patients with target mismatch did not meet the clinical mismatch criteria were either because the National Institutes of Health Stroke Scale (NIHSS) score was 6 to 9 points (a minimum NIHSS score of 10 points is required for clinical mismatch) or the infarct core volume was higher than that allowed by the clinical mismatch criteria. In patients selected with the target mismatch profile in the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) s...
Source: JAMA Neurology - Category: Neurology Source Type: research