Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.
Publication/Presentation Date
12-21-2023
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.
Volume
15
Issue
e3
First Page
331
Last Page
331
ISSN
1759-8486
Published In/Presented At
Shaban, A., Al Kasab, S., Chalhoub, R. M., Bass, E., Maier, I., Psychogios, M. N., Alawieh, A., Wolfe, S. Q., Arthur, A. S., Dumont, T. M., Kan, P., Kim, J. T., De Leacy, R., Osbun, J. W., Rai, A. T., Jabbour, P., Park, M. S., Crosa, R. J., Mascitelli, J. R., Levitt, M. R., … Samaniego, E. A. (2023). Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours. Journal of neurointerventional surgery, 15(e3), e331–e336. https://doi.org/10.1136/jnis-2022-019372
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36593118
Department(s)
Administration and Leadership
Document Type
Article