Background and Purpose Recent trials showed a clear benefit of mechanical thrombectomy for patients with emergent large vessel occlusion and large core infarction. However, limited number of patients were included in the late window. This study aimed to compare outcomes of low ASPECTS stroke patients who underwent mechanical thrombectomy in the early versus late time window.
Methods A retrospective cohort study was conducted using data from the Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023. Patients with low ASPECTS (2-5) who underwent mechanical thrombectomy for ICA or M1 stroke were included. Patients were divided into early (within 6 hours) and late (6-24 hours) time window groups. The primary outcome was 90-day favorable outcome (modified Rankin Scale [mRS] score 0-3).
Results Among the 10,081 patients who underwent mechanical thrombectomy, 387 met the inclusion criteria. Of those, 219 (56.6%) were treated in the early window. Median (IQR) age was 70.4 (60-78) years, 180 (46.5%) were female, and 221 (68.4%) were White. There was no significant difference in successful recanalization rates (Thrombolysis in Cerebral Infarction [TICI] 2C/3) between the early and late window groups (56.6% versus 52.4%, P=0.478). Additionally, there was no significant difference in favorable outcomes at 90 days between the two groups (25.4% versus 35.9%, P=0.142). In Binary regression analysis, age (OR 0.94; 95% CI 0.92-0.97; P<0.001), admission NIHSS (OR 0.88; 95% CI 0.83-0.94; P<0.001), and successful recanalization (OR 4.01; 95% CI 1.94-8.71; P<0.001) were predictors of a favorable outcome at 90 days.
Conclusion Mechanical thrombectomy appears to carry a similar benefit profile among patients treated in the late window as those in the early window.
Disclosures S. Samir Elawady: None. M. Mahdi Sowlat: None. I. Maier: None. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: None. M. Psychogios: None. E. Samaniego: None. A. Arthur: None. S. Yoshimura: None. J. A. Grossberg: None. A. Alawieh: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. S. Park: None. M. R. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson Jr: None. P. Navia: None. A. M Spiotta: None. S. Al Kasab: None.
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