Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy

Sebastian Stösser, Felix J Bode, Julius N Meissner, Johannes M Weller, Christine Kindler, Malte Sauer, Daniel Paech, Christoph Riegler, Christian H Nolte, Amitis Pourian, Joachim Röther, Nadja Selo, Ulrike Ernemann, Sven Poli, Rosa Marie Eckert, Georg Bohner, Korbinian Scherling, Franziska Dorn, Gabor C Petzold, GSR-ET study group, Sebastian Stösser, Felix J Bode, Julius N Meissner, Johannes M Weller, Christine Kindler, Malte Sauer, Daniel Paech, Christoph Riegler, Christian H Nolte, Amitis Pourian, Joachim Röther, Nadja Selo, Ulrike Ernemann, Sven Poli, Rosa Marie Eckert, Georg Bohner, Korbinian Scherling, Franziska Dorn, Gabor C Petzold, GSR-ET study group

Abstract

Purpose: Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS.

Methods: We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome.

Results: Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score.

Conclusion: The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.

Keywords: Acute ischemic stroke; Large vessel occlusion stroke; Modified Rankin Scale; Stroke registry; Thrombectomy.

Conflict of interest statement

S. Stösser, F.J. Bode, J.N. Meissner, J.M. Weller, C. Kindler, M. Sauer, D. Paech, C.H. Nolte, A. Pourian, J. Röther, N. Selo, U. Ernemann, S. Poli, R.M. Eckert, G. Bohner, K. Scherling, and G.C. Petzold declare that they have no competing interests. F. Dorn received research funding from Cerenovus, received speakers honorary from Cerenovus and Acandis and serves as a proctor and consultant for Cerus Endovascular, Balt and Cerenovus. C. Riegler received travel grants by Acticor Biotech.

© 2022. The Author(s).

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