Journal article
Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis
Journal of neurointerventional surgery, Vol.16(7), pp.670-676
06/24/2023
DOI: 10.1136/jnis-2023-020443
PMID: 37355251
Abstract
Different studies have demonstrated the benefit of endovascular treatment (EVT) up to 24 hours after acute ischemic stroke (AIS) onset. Recent cohort observational studies suggest that patients with large vessel occlusion AIS may benefit from EVT beyond 24 hours from the last known well (LKW) when adequately selected. We aimed to examine the safety and efficacy of EVT beyond 24 hours from LKW using a meta-analysis of all the literature available.
A systematic search from inception to April 2023 was conducted for studies including AIS patients with EVT beyond 24 hours from LKW in Medline, Embase, Scopus, and Web of Science. Outcomes of interest included favorable functional outcome (90-day modified Rankin scale (mRS) 0-2), successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Data were pooled using a random-effects model.
Twelve studies with 894 patients were included. The rate of favorable functional outcome was 40% (95% CI 31% to 49%; I
=76%). The rate of successful reperfusion was 83% (95% CI 80% to 85%; I
=0%). The sICH rate was 7% (95% CI 5% to 9%; I
=0%) and the 90-day mortality rate was 28% (95% CI 24% to 33%; I
=0%). There was no significant difference in favorable outcomes (OR=0.69; 95% CI 0.41 to 1.14) and 90-day mortality (OR=1.35; 95% CI 0.90 to 2.00) among patients who underwent EVT <24 hours versus >24 hours.
EVT beyond 24 hours from LKW may achieve favorable clinical outcomes and high reperfusion rates, with acceptable intracranial hemorrhage rates in selected patients. Considering the current certainty of the evidence and heterogenous individual study results, larger prospective trials are warranted.
Details
- Title: Subtitle
- Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis
- Creators
- Aaron Rodriguez-Calienes - University of IowaMilagros Galecio-Castillo - University of Iowa Hospitals and ClinicsJuan Vivanco-Suarez - University of Iowa Hospitals and ClinicsGhada A Mohamed - Medical University of South CarolinaGabor Toth - Cleveland ClinicAmrou Sarraj - University Hospitals of ClevelandDeep Pujara - University Hospitals of ClevelandAj A Chowdhury - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMudassir Farooqui - University of IowaMalik Ghannam - University of Iowa Hospitals and ClinicsEdgar A Samaniego - University of Iowa Hospitals and ClinicsTudor G Jovin - Cooper University HospitalSantiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.16(7), pp.670-676
- DOI
- 10.1136/jnis-2023-020443
- PMID
- 37355251
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Language
- English
- Electronic publication date
- 06/24/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Orthopedics and Rehabilitation; Neurosurgery
- Record Identifier
- 9984438856202771
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