Endovascular thrombectomy beyond 24 hours from ischemic stroke onset: A propensity score matched cohort study

Singh Dhillon, Permesh; Butt, Waleed; Podlasek, Anna; Barrett, Emma; McConachie, Norman; Lenthall, Robert; Nair, Sujit; Malik, Luqman; James, Martin A; Dineen, Robert A; England, Timothy J

Abstract

Background: The safety and functional outcome of endovascular thrombectomy (EVT) in the very late (VL; >24 hours) time window from ischemic stroke onset remains undetermined. Methods: Using data from a national stroke registry, we used propensity score matched (PSM) individual level data of patients who underwent EVT, selected with CT perfusion or non-contrast CT/CT angiography, between October 2015 and March 2020. Functional and safety outcomes were assessed in both late (6-24 hours) and VL time windows. Subgroup analysis was performed of imaging selection modality in the VL time window. Results: We included 1150 patients (late window: 1046 (208 after PSM); VL window: 104 (104 after PSM)). Compared with EVT treatment initiation between 6 and 24 hours, patients treated in the VL window had similar modified Rankin Scale (mRS) scores at discharge (ordinal shift; common OR=1.08, 95% CI 0.69 to 1.47, p=0.70). No significant differences in achieving good functional outcome (mRS ≤2 at discharge; 28.8% (VL) vs 29.3% (late), OR=0.97, 95% CI 0.58 to 1.64, p=0.93), successful reperfusion (modified Thrombolysis in Cerebral Infarction score of 2b-3) (p=0.77), or safety outcomes of symptomatic intracranial hemorrhage (p=0.43) and inhospital mortality (p=0.23) were demonstrated. In the VL window, there was no significant difference in functional outcome among patients selected with perfusion versus those selected without perfusion imaging (common OR=1.38, 95% CI 0.81 to 1.76, p=0.18). Conclusion: In this real world study, EVT beyond 24 hours from stroke onset or last known well appeared to be feasible, with comparable safety and functional outcomes to EVT initiation between 6 and 24 hours. Randomized trials assessing the efficacy of EVT in the VL window are warranted, but may only be feasible with a large international collaborative approach.

Citation

Singh Dhillon, P., Butt, W., Podlasek, A., Barrett, E., McConachie, N., Lenthall, R., Nair, S., Malik, L., James, M. A., Dineen, R. A., & England, T. J. (2023). Endovascular thrombectomy beyond 24 hours from ischemic stroke onset: A propensity score matched cohort study. Journal of NeuroInterventional Surgery, 15(3), 233-237. https://doi.org/10.1136/neurintsurg-2021-018591

• Journal Article Type: Article
• Acceptance Date: Jan 30, 2022
• Online Publication Date: Feb 15, 2022
• Publication Date: 2023-03
• Deposit Date: Feb 10, 2022
• Publicly Available Date: Feb 15, 2022
• Journal: Journal of NeuroInterventional Surgery
• Print ISSN: 1759-8478
• Electronic ISSN: 1759-8486
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 3
• Pages: 233-237
• DOI: https://doi.org/10.1136/neurintsurg-2021-018591
• Public URL: https://nottingham-repository.worktribe.com/output/7414942
• Publisher URL: https://jnis.bmj.com/content/early/2022/02/14/neurintsurg-2021-018591