TY - JOUR T1 - Time for a Time Window Extension: Insights from Late Presenters in the ESCAPE Trial JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 102 LP - 106 DO - 10.3174/ajnr.A5462 VL - 39 IS - 1 AU - J.W. Evans AU - B.R. Graham AU - P. Pordeli AU - F.S. Al-Ajlan AU - R. Willinsky AU - W.J. Montanera AU - J.L. Rempel AU - A. Shuaib AU - P. Brennan AU - D. Williams AU - D. Roy AU - A.Y. Poppe AU - T.G. Jovin AU - T. Devlin AU - B.W. Baxter AU - T. Krings AU - F.L. Silver AU - D.F. Frei AU - C. Fanale AU - D. Tampieri AU - J. Teitelbaum AU - D. Iancu AU - J. Shankar AU - P.A. Barber AU - A.M. Demchuk AU - M. Goyal AU - M.D. Hill AU - B.K. Menon A2 - , Y1 - 2018/01/01 UR - http://www.ajnr.org/content/39/1/102.abstract N2 - BACKGROUND AND PURPOSE: The safety and efficacy of endovascular therapy for large-artery stroke in the extended time window is not yet well-established. We performed a subgroup analysis on subjects enrolled within an extended time window in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) trial.MATERIALS AND METHODS: Fifty-nine of 315 subjects (33 in the intervention group and 26 in the control group) were randomized in the ESCAPE trial between 5.5 and 12 hours after last seen healthy (likely to have groin puncture administered 6 hours after that). Treatment effect sizes for all relevant outcomes (90-day mRS shift, mRS 0–2, mRS 0–1, and 24-hour NIHSS scores and intracerebral hemorrhage) were reported using unadjusted and adjusted analyses.RESULTS: There was no evidence of treatment heterogeneity between subjects in the early and late windows. Treatment effect favoring intervention was seen across all clinical outcomes in the extended time window (absolute risk difference of 19.3% for mRS 0–2 at 90 days). There were more asymptomatic intracerebral hemorrhage events within the intervention arm (48.5% versus 11.5%, P = .004) but no difference in symptomatic intracerebral hemorrhage.CONCLUSIONS: Patients with an extended time window could potentially benefit from endovascular treatment. Ongoing randomized controlled trials using imaging to identify late presenters with favorable brain physiology will help cement the paradigm of using time windows to select the population for acute imaging and imaging to select individual patients for therapy.ICHintracerebral hemorrhage ER -