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A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct

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Date 2017 Sep 29
PMID 28955507
Citations 3
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Abstract

Purpose: The safety and efficacy of endovascular thrombectomy (EVT) for patients with proximal occlusive stroke presenting beyond 6 hours and selected on the basis of favorable neuroimaging remains unclear.

Materials And Methods: A systematic search was performed from four electronic databases from their inception to Jan 2017. A meta-analysis of outcomes from studies with patients treated beyond 6 hours was compared to those treated within the established 6 hour therapeutic window in randomized trials, selected using conventional imaging methods with CT/CT angiography.

Results: A total of 8 articles met inclusion criteria for the study population (a prospective single-center study, 5 retrospective single-center studies and 2 retrospective multicenter studies). These were compared to the results of three prospective trials of patients treated within 6 hours selected using CT/CT angiography. For patients treated >6 hours and <6 hours respectively, the weighted mean age was 64.7 vs. 67.0 years; the presenting NIHSS was 15.7 vs. 17.1 and the time from symptom onset to puncture was 4.0 hours vs. 15.1 hours. Weighted pooled estimates of successful recanalization (TIMI 2/3 or TICI 2b/3) and favorable outcome (mRS ≤2) were similar between both groups, 70.1% vs. 70.6%, P=0.75 and 38.9% vs. 38.4%, P=0.88 respectively. Pooled mortality measured at 3 months was 22.8% for those treated >6 hours and 12.5% for <6 hours, P<0.0001. Symptomatic intracranial hemorrhage was not significantly different (10.0% vs. 7.7%, P=0.33).

Conclusion: When compared to established methods of patient selection, EVT employed beyond 6 hours in those selected with imaging to exclude large core infarcts achieves similar rates of recanalization, and functional outcome but there is a significant increase in mortality despite no increase in symptomatic intracranial hemorrhage.

Citing Articles

Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry.

Meinel T, Kaesmacher J, Mordasini P, Mosimann P, Jung S, Arnold M Ther Adv Neurol Disord. 2019; 12:1756286419835708.

PMID: 30944585 PMC: 6437320. DOI: 10.1177/1756286419835708.


[Intensive care studies from 2017/2018].

Reuss C, Bernhard M, Beynon C, Hecker A, Jungk C, Nusshag C Anaesthesist. 2018; 67(9):679-708.

PMID: 30083994 DOI: 10.1007/s00101-018-0474-x.


Mechanical Thrombectomy in Strokes with Large-Vessel Occlusion Beyond 6 Hours: A Pooled Analysis of Randomized Trials.

Vidale S, Longoni M, Valvassori L, Agostoni E J Clin Neurol. 2018; 14(3):407-412.

PMID: 29971982 PMC: 6032006. DOI: 10.3988/jcn.2018.14.3.407.

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