Journal article
Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours
Journal of neurointerventional surgery, Vol.15(e3), pp.e331-e336
12/2023
DOI: 10.1136/jnis-2022-019372
PMID: 36593118
Abstract
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.
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.
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).
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.
Details
- Title: Subtitle
- Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours
- Creators
- Amir Shaban - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA amir-shaban@uiowa.eduSami Al Kasab - Medical University of South CarolinaReda M Chalhoub - Medical University of South CarolinaEric Bass - Medical University of South CarolinaIlko Maier - Neurology, University Medicine Goettingen, Goettingen, GermanyMarios-Nikos Psychogios - University Hospital of BaselAli Alawieh - Emory UniversityStacey Q Wolfe - Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USAAdam S Arthur - University of Tennessee Health Science CenterTravis M Dumont - Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USAPeter Kan - The University of Texas Medical Branch at GalvestonJoon-Tae Kim - Chonnam National University HospitalReade De Leacy - Icahn School of Medicine at Mount SinaiJoshua W Osbun - Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USAAnsaar T Rai - West Virginia UniversityPascal Jabbour - Thomas Jefferson UniversityMin S Park - Barrow Neurological InstituteRoberto Javier Crosa - Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, UruguayJustin R Mascitelli - The University of Texas Health Science Center at San AntonioMichael R Levitt - University of Washington School of MedicineAdam J Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USAWalter Casagrande - Neurosurgery, Hospital Juan A. Fernandez, Buenos Aires, ArgentinaShinichi Yoshimura - Hyogo Medical UniversityCharles Matouk - University of New HavenRichard Williamson - Baptist Medical Center JacksonvilleBenjamin Gory - Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, FranceMaxim Mokin - Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USAIsabel Fragata - Centro Hospitalar de Lisboa CentralDaniele G Romano - Policlinico "Santa Maria alle Scotte", Unit of Neuroimaging and Neurointervention Siena, IT, University Hospital of Siena, Siena, ItalyShakeel Chowdry - NorthShore University HealthSystemMark Moss - Washington Regional Medical CenterDaniel Behme - University Hospital MagdeburgKaustubh Limaye - Indiana University BloomingtonAlejandro M Spiotta - Medical University of South CarolinaEdgar A Samaniego - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.15(e3), pp.e331-e336
- DOI
- 10.1136/jnis-2022-019372
- PMID
- 36593118
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Grant note
- DOI: 10.13039/100020501, name: Penumbra, award: N/A; DOI: 10.13039/100004374, name: Medtronic, award: N/A; DOI: 10.13039/100008894, name: Stryker, award: N/A
- Language
- English
- Electronic publication date
- 01/02/2023
- Date published
- 12/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984354393602771
Metrics
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