Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours

• Type of Material: Article
• Authors: Ghada A Mohamed, University of South Carolina (MUSC); Raul Nogueira, Emory University; Muhammed Amir Essibayi, Albert Einstein College of Medicine; Hassan Aboul-Nour, Emory University; Mahmoud Mohammaden, Emory University; Diogo Haussen, Emory University; Aldo Mendez Ruiz, University of Pittsburgh; Bradley A Gross, University of Pittsburgh; Okkes Kuybu, University of Pittsburgh; Mohamed M Salem, Hospital of the University of Pennsylvania; Jan-Karl Burkhardt, Hospital of the University of Pennsylvania; Brian Jankowitz, Hospital of the University of Pennsylvania; James E Siegler, Cooper University Medical Center; Pratit Patel, Cooper University Medical Center; Taryn Hester, Cooper University Hospital; Santiago Ortega-Gutierrez, University of Iowa Hospitals and Clinics; Mudassir Farooqui, University of Iowa Hospitals and Clinics; Milagros Galecio-Castillo, University of Iowa Hospitals and Clinics; Thanh N Nguyen, Boston University; Mohamad Abdalkader, Boston University; Piers Klein, Boston University; Jude H Charles, Boston University; Vasu Saini, University of Miami; Dileep R Yavagal, University of Miami; Ammar Jumah, Henry Ford Health, Detroit; Ali Alaraj, University of Illinois at Chicago; Sophia Peng, University of Illinois at Chicago; Muhammad Hafeez, University of Illinois at Chicago; Omar Tanweer, University of Illinois at Chicago; Peter Kan, Baylor School of Medicine; Jacopo Scaggiante, Baylor School of Medicine; Stavros Matsoukas, Baylor School of Medicine; Johanna T Fifi, Icahn School of Medicine at Mount Sinai; Stephan A Mayer, Westchester Medical Center; Alex B Chebl, Henry Ford Hlth
• Language: English
• Date: 2023-05-01
• Publisher: KOREAN STROKE SOC
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Korean Stroke Society
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.5853/jos.2023.00017
• Title of Journal or Parent Work: JOURNAL OF STROKE
• Volume: 25
• Issue: 2
• Start Page: 282
• End Page: +
• Grant/Funding Information: None
• Keywords: Peripheral Vascular Disease; SELECTION PARADIGMS; Life Sciences & Biomedicine; ACUTE ISCHEMIC-STROKE; Delayed treatment; Thrombectomy; Clinical Neurology; Cardiovascular System & Cardiology; Ischemic stroke; Science & Technology; Neurosciences & Neurology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). Methods This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). Results Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. Conclusion In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.