Background Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window.
Methods A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours. We selected a matched control group from patients who underwent thrombectomy in the 6–24-hour window. We used functional independence at 3 months as our primary outcome measure.
Results We identified 121 patients who underwent thrombectomy beyond 24 hours and 1824 in the 6–24-hour window. We selected a 2:1 matched group of patients with thrombectomy 6–24 hours as a comparison group. Patients undergoing thrombectomy beyond 24 hours were less likely to be independent at 90 days (18 (18.8%) vs 73 (34.9%), P=0.005). They had higher odds of mortality at 90 days in the adjusted analysis (OR 2.34, P=0.023). Symptomatic intracerebral hemorrhage and other complications were similar in the two groups. In a multivariate analysis only lower number of attempts was associated with good outcomes (OR 0.27, P=0.022).
Conclusions Mechanical thrombectomy beyond 24 hours appears to be safe and tolerable with no more hemorrhages or complications compared with standard of care thrombectomy. Outcomes and mortality in this time window are worse compared with an earlier time window, but the rates of good outcomes may justify this therapy in selected patients.
- CT perfusion
Data availability statement
Data are available upon reasonable request.
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Contributors All coauthors read and reviewed the manuscripts and agree with the publication. They all contributed to the study being published. Authors’ contributions:
Concept design: AS, ES, AS
Drafting manuscript: AS
Data acquisition, revision, editing, approval of final draft: SK, RC, EB, IM, MP, AA,TD, SW,AA, PK, JK, RDL, JO, AR, PJ, MP, RC, JM, ML, AP, WC, SY, CM. RW, BG, MM, IF, DR, SC, MM, DB, KL
Data analysis: RC
Funding STAR registry receives funding from Penumbra, Stryker and Medtronic.
Competing interests PK: consultant for Stryker NV and Imperative Care. On the editorial board of JNIS. DRG: Balt Italy: Consultant, Microvention Europe: Consultant, Penumbra Inc: Consultant. AMS: Penumbra: Research support, Consultant. Stryker: Research support, Consultant. Cerenovus: Consultant. Terumo: Consultant. IschemaView Inc/Rapid AI: Research support, Consultant. ASA: Consultant for Arsenal, Balt, Johnson and Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, Stryker Research support from Balt, Medtronic, Microvention, Penumbra and Siemens Shareholder Azimuth, Bendit, Cerebrotech, Endostream, Magneto, Mentice, Neurogami, Serenity, Synchron, Triad Medical, Vastrax, VizAI. RDL: Consultant - Imperative Care, Stryker, Cerenovus, Spartan Micro. Research support – Siemens. On the editorial board of JNIS. ML: On the editorial board of JNIS. MM: On the editorial board of JNIS. JM: Consultant Stryker. On the editorial board of JNIS. MSP: Clinical Events Committee/Consultant for Medtronic. AP: consultant for Stryker and Depuy Synthes. ES: Consultant for Medtronic/Microvention/Rapid Medical.
Provenance and peer review Not commissioned; externally peer reviewed.
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