Purpose With thrombectomy for anterior circulation large vessel occlusion (ACLVO) stroke, time to recanalization is considered important, but collateral status may be a greater driver of outcome than time. We tested the hypothesis that patients with ACLVO stroke who present with a small core infarct on DWI would show similar good outcomes after thrombectomy, regardless of time from onset.
Materials and methods A cohort of 49 patients treated with thrombectomy after MR selection for ACLVO stroke from 11/1/2012 until 5/15/2015 was retrospectively reviewed. Patients were selected for thrombectomy based on DWI screening with presentation core volume ≤100 age considered favorable. Patients were divided into early (n = 24) or extended (n = 25) treatment groups, with intention to treat ≤6 hours = early, and comparisons made with final infarct volume the primary outcome.
Results Baseline characteristics were similar (early versus extended), including admission NIHSSS (IQR 13–19 versus 11–18). Recanalization ≥ TICI2B was 79% and 83% respectively. There was no significant difference in median final infarct volume (16 mL versus 22 mL, estimated difference +4 mL [95 CI: –13 – +19], p = 0.61) or median infarct growth (1 mL versus 5 mL, estimated difference 1.0 mL [95 CI: –7.0 – +10], p = 0.71). For decision to treat up to 20 hours after onset, time did not correlate with final infarct volume, Figure 1. Similar rates of complications and mortality were observed.
Conclusion Using MR selection, similar good outcomes after thrombectomy for ACLVO stroke may be achieved well beyond 6 hours.
Disclosures B. Cristiano: None. M. Pond: None. S. Basu: None. U. Oyoyo: None. J. Jacobson: 4; C; GeneLux.
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