Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.

Abstract

BACKGROUND:

Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window.

METHODS:

A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours. We selected a matched control group from patients who underwent thrombectomy in the 6-24-hour window. We used functional independence at 3 months as our primary outcome measure.

RESULTS:

We identified 121 patients who underwent thrombectomy beyond 24 hours and 1824 in the 6-24-hour window. We selected a 2:1 matched group of patients with thrombectomy 6-24 hours as a comparison group. Patients undergoing thrombectomy beyond 24 hours were less likely to be independent at 90 days (18 (18.8%) vs 73 (34.9%), P=0.005). They had higher odds of mortality at 90 days in the adjusted analysis (OR 2.34, P=0.023). Symptomatic intracerebral hemorrhage and other complications were similar in the two groups. In a multivariate analysis only lower number of attempts was associated with good outcomes (OR 0.27, P=0.022).

CONCLUSIONS:

Mechanical thrombectomy beyond 24 hours appears to be safe and tolerable with no more hemorrhages or complications compared with standard of care thrombectomy. Outcomes and mortality in this time window are worse compared with an earlier time window, but the rates of good outcomes may justify this therapy in selected patients.

• Authors: Amir Shaban, Sami Al Kasab, Reda M Chalhoub, Eric Bass, Ilko Maier, Marios-Nikos Psychogios, Ali Alawieh, Stacey Q Wolfe, Adam S Arthur, Travis M Dumont, Peter Kan, Joon-Tae Kim, Reade De Leacy, Joshua W Osbun, Ansaar T Rai, Pascal Jabbour, Min S Park, Roberto Javier Crosa, Justin R Mascitelli, Michael R Levitt, Adam J Polifka, Walter Casagrande, Shinichi Yoshimura, Charles Matouk, Richard Williamson, Benjamin Gory, Maxim Mokin, Isabel Fragata, Daniele G Romano, Shakeel A Chowdhry, Mark Moss, Daniel Behme, Kaustubh Limaye, Alejandro M Spiotta, Edgar A Samaniego
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 15 Issue e3 Pg. e331-e336 (Dec 21 2023) ISSN: 1759-8486 [Electronic] England
• PMID: 36593118 (Publication Type: Multicenter Study, Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Humans
• Brain Ischemia (diagnostic imaging, surgery, complications)
• Stroke (diagnostic imaging, surgery, etiology)
• Thrombectomy (adverse effects)
• Cerebral Hemorrhage (etiology)
• Endovascular Procedures (adverse effects)
• Treatment Outcome