Background The DEFUSE 3 and DAWN trials have shown the benefit of thrombectomy beyond 6 hours of stroke symptom onset in carefully selected patients.
Objective To evaluate the real-world outcomes of stent retriever thrombectomy beyond 6 hours of stroke onset using combined individual patient data from the North American Solitaire 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 outcomes of patients presenting within the first hours 6 or beyond 6 hours of stroke symptom onset.
Results Of 830 patients with anterior circulation AIS from the NASA and TRACK registries, 32.7% (271 patients) underwent thrombectomy beyond the first 6 hours of symptom onset. The rates of good clinical outcome (modified Rankin scale score of 0–2 at 90 days), mortality, and symptomatic intracranial hemorrhage were similar: 48.1%, 20.6%, and 8.0% within 0–6 hours, 46.2%, 21.6%, and 10.9% within 6–16 hours, and 38.9%, 33.3%, and 5% within 16–24 hours (p=0.8, 0.6, and 0.5, respectively). The rates of successful recanalization (Thrombolysis in Cerebral Infarction 2b/3) were 79.4% in patients with stroke within 0–6 hours, 72.6% within 6–16 hours, and 85.0% within 16–24 hours (p=0.04).
Conclusions Real-world experience with patients with anterior circulation AIS treated with the Solitaire and Trevo thrombectomy devices beyond the first 6 hours of symptom onset proved to be equally safe and effective as for patients with symptom onset within the first 6 hours.
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Contributors MM and OOZ: study concept and design; wrote the manuscript. OOZ: statistical analysis. All authors participated in data collection and analysis, edited the manuscript, and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JDE: honoraria from Medtronic, Stryker Neurovascular, and Penumbra. MM: consultant for Cerebrotech, speaker for Penumbra, Canon Medical. RGN, OOZ: consultant/advisory board member for Styker Neurovascular, Covidien.
Patient consent Not required.
Ethics approval Institutional review board at each participating site.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are presented in this paper.
Collaborators The NASA investigators: Osama O. Zaidat, Alicia C. Castonguay, Italo Linfante; Rishi Gupta, Coleman O. Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English,; Guilherme Dabus, MD; Tim W. Malisch, Franklin A. Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Michael T. Froehler, Aamir Badruddin, Thanh N. Nguyen, M. Asif Taqi, Michael G. Abraham, Albert J. Yoo, Vallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Alex Abou-Chebl, Peng R. Chen, Gavin W. Britz, Chung-Huan J. Sun, Vibhav Bansal, Ritesh Kaushal, Ashish Nanda, Raul G. Nogueira. The TRACK registry local investigators: Osama O Zaidat, Alicia C Castonguay, Raul G Nogueira, Diogo C Haussen, Joey D English, Sudhakar R Satti, Jennifer Chen, Hamed Farid, Candace Borders, Erol Veznedaroglu, Mandy J Binning, Ajit Puri, Nirav A Vora, Ron F Budzik, Guilherme Dabus, Italo Linfante, Vallabh Janardhan, Amer Alshekhlee, Michael G Abraham, Randall Edgell, Muhammad Asif Taqi, Ramy El Khoury, Maxim Mokin, Aniel Q Majjhoo, Mouhammed R Kabbani, Michael T Froehler, Ira Finch, Sameer A Ansari, Roberta Novakovic, Thanh N Nguyen.