TISSUE CLOCK BEYOND TIME CLOCK: ENDOVASCULAR THROMBECTOMY FOR PATIENTS WITH LARGE VESSEL OCCLUSION STROKE BEYOND 24-HOURS
Recommended Citation
Mohamed GA, Nogueira RG, Essibayi MA, Aboul-Nour H, Mohammaden M, Haussen DC, Mendez Ruiz A, Gross BA, Kuybu O, Salem MM, Burkhardt J, Jankowitz B, Siegler JE, Patel P, Hester T, Ortega-Gutierrez S, Farooqui M, Galecio-Castillo M, Nguyen TN, Abdalkader M, Klein P, Charles JH, Yavagal DR, Saini V, Jum'ah A, Alaraj A, Peng S, Hafeez M, Tanweer O, Kan P, Scaggiante J, Matsoukas S, Fifi JT. TISSUE CLOCK BEYOND TIME CLOCK: ENDOVASCULAR THROMBECTOMY FOR PATIENTS WITH LARGE VESSEL OCCLUSION STROKE BEYOND 24-HOURS. Eur Stroke J 2023; 8(2):6.
Document Type
Conference Proceeding
Publication Date
5-1-2023
Publication Title
Eur Stroke J
Abstract
Background and aims: 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 eleven comprehensive stroke centers in the US beyond 24-hours from LKW between 01/2015-12/2021.We assessed 90-days 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 (66±15 vs. 62±55 years, p= 0.047) and had a higher baseline NIHSS (16±7 vs.10±9, p=<0.001). Successful recanalization (TICI 2b-3) was achieved in 83%, and 5.6% had symptomatic ICH compared to 2.5% in the SMT group (p=0.19). MT was associated with mRS (0-2) at 90-days (aOR 5.73, p=0.02), 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 0.01), ASPECTS score ≥8 (aOR 3.06, p=0.04) and collaterals scores aOR (1.41, p=0.027) were associated with 90-day functional independence. Conclusions: 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.
PubMed ID
Not assigned.
Volume
8
Issue
2
First Page
6
