Background and purpose The DEFUSE 3 and DAWN trials have shown the benefit of thrombectomy beyond 6 hours of stroke symptom onset. The purpose of this study is to evaluate the real-world outcomes of patients treated with stent retriever thrombectomy beyond 6 hours of stroke onset using combined individual patient data from the North American Solitiare Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries.
Methods Pooled analysis of individual patient data of all cases of anterior circulation acute ischemic stroke (AIS) from NASA and TRACK was performed to compare radiographic and clinical outcomes of patients presenting within first 6 or beyond 6 hours of stroke symptom onset.
Results Out of 830 patients with anterior circulation AIS patients from the NASA and TRACK registries, 32.7% (271 patients) underwent thrombectomy beyond the first 6 hours of symptom onset. There was a similar distribution of age and cerebrovascular risk factors in patients arriving within the first 6 and beyond 6 hours of stroke symptom onset. Both groups of patients had similar approaches to thrombectomy using the Solitaire (NASA registry) and Trevo (TRACK registry) stent retrievers, including the use of a balloon-guide catheter, continuous aspiration or general anesthesia (p=0.12, 0.15 and 0.52, respectively). The rates of successful recanalization, defined as TICI 2b/3, were 79.4% in patients within stroke 0–6 hours, 75.6% within 6–16 hours and 85.0% within 16–24 hours (p=0.04). The rates of good clinical outcome, defined as modified Rankin Scale 0–2, mortality and symptomatic Intracerebral hemorrhage were similar: 48.2%, 20.6% and 8.0% within 0–6 hours, 46.2%, 21.6% and 11.02 within 6–16 hours, and 38.9%, 33.3% and 5% within 616 hours (p=0.8, 0.6 and 0.5, respectively).
Conclusions In real world experience with patients who presented with anterior circulation AIS, using the Solitaire and Trevo thrombectomy devices beyond the first 6 hours of symptom onset proved to be equally safe and effective when compared to patients with symptom onset within the first 6 hours.
Disclosures M. Mokin: 2; C; Canon medical. A. Abou-Chebl: None. A. Castonguay: None. R. Nogueira: 1; C; Stryker, Medtronic, Penumbra. 2; C; Styker Neurovascular, Covidien. J. English: 2; C; Stryker. H. Farid: None. R. Gupta: 2; C; Stryker. C. Martin: None. W. Holloway: None. D. Haussen:None. N. Mueller-Kronast: None. O. Zaidat: 2; C; Stryker, Medtronic.
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