Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours

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. LevittAdam J. Polifka, Walter Casagrande, Shinichi Yoshimura, Charles Matouk, Richard Williamson, Benjamin Gory, Maxim Mokin, Isabel Fragata, Daniele G. Romano, Shakeel Chowdry, Mark Moss, Daniel Behme, Kaustubh Limaye, Alejandro M. Spiotta, Edgar A. Samaniego

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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.

Original languageEnglish (US)
Article numberjnis-2022-019372
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2023
Externally publishedYes

Keywords

  • CT perfusion
  • Stroke
  • Thrombectomy
  • Thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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