Association between different onset types and clinical outcomes in patients with large ischemic stroke following...

This study aimed to explore the association between different stroke onset types [unwitnessed stroke (UWS) vs. witnessed stroke (WS)] and clinical outcomes in patients with large ischemic stroke treated with endovascular therapy (EVT).

Patients with acute large ischemic stroke were recruited from a prospective registry. The primary effectiveness outcome was the modified Rankin Scale score (mRS) 0-3 at 90 d, and the secondary effectiveness outcomes included the distribution of mRS scores. The safety outcomes were mortality at 90 d and symptomatic intracranial hemorrhage (sICH) within 48  h. Multivariable logistic regression and propensity score matching were used for statistical analyses.

488 eligible patients were included in this analysis, with 100 (20.5 %) patients in the UWS group and 388 (79.5 %) in the WS group. The primary effectiveness outcome (mRS 0-3) of the UWS group was similar to that of the WS group (29/100, 29.0 % vs 151/388, 38.9 %; adjusted odds ratio (aOR) 0.75, 95 % CI 0.43 to 1.31, P = 0.317), and comparable results were obtained for the secondary effectiveness outcomes. Additionally, no significant difference was observed in mortality at 90 d and the rates of sICH within 48  h. Findings were consistent across both propensity score-matched and inverse probability of treatment weighting analyses.

No significant differences in functional or safety outcomes were observed between the UWS and WS groups among patients with large ischemic stroke. These findings suggest that onset type alone may not preclude EVT consideration, although further studies are needed to validate these results.