You are here

Article Text

Article menu

Download PDFPDF

SNIS 20th annual meeting electronic poster abstracts
E-240 Endovascular thrombectomy beyond 24 hours of last known well: a systematic review and meta-analysis
Free
  1. A Rodriguez-Calienes1,
  2. M Galecio-Castillo2,
  3. J Vivanco-Suarez2,
  4. M Farooqui2,
  5. S Ortega-Gutierrez3
  1. 1Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
  2. 2Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
  3. 3Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Abstract

Background 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 performed a systematic review and meta-analysis to determine whether EVT can benefit patients presenting beyond 24 hours from LKW compared to best medical therapy (BMT).

Methods A systematic search from inception to March 2023 was conducted in Medline, Embase, Scopus, and Web of Science. The primary outcome was favorable functional outcome (90-day modified Rankin Scale 0-2), and secondary outcomes included 90-day mortality and rate of symptomatic intracranial hemorrhage (sICH). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome.

Results Four nonrandomized comparative studies with 1153 patients, 428 patients in the EVT arm and 275 patients in the BMT arm, were included in the meta-analysis. Patients treated with EVT showed a trend toward higher favorable functional outcome rates (EVT: 32.9% vs. BMT: 22.6%; OR=1.75, 95% CI 0.43-7.05). EVT resulted in lower rates of mortality when compared to BMT (EVT: 30.3% vs. BMT: 40.2%; OR=0.64, 95% CI 0.45-0.90). However, EVT patients had higher rates of sICH (EVT: 7.9% vs. BMT: 1.8%; OR=3.80, 95% CI 1.56-9.25).

Conclusion EVT beyond 24 hours from LKW trended toward improved clinical outcomes compared with BMT, despite increased odds of sICH. Considering the current certainty of the evidence and heterogenous individual study results, larger prospective trials are warranted.

Abstract E-240 Figure 1
Abstract E-240 Figure 1

Disclosures A. Rodriguez-Calienes: None. M. Galecio-Castillo: None. J. Vivanco-Suarez: None. M. Farooqui: None. S. Ortega-Gutierrez: 1; C; NIH-NINDS (R01NS127114-01). 2; C; Medtronic, Stryker.

https://doi.org/10.1136/jnis-2023-SNIS.339

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.