Data presented at the International Stroke Conference 2021 adds to the literature on the efficacy and safety of endovascular thrombectomy in patients with large vessel occlusion presenting more than 24 hours from last known wellness (LKW).

Researchers analyzed outcomes from 2012 to 2021 across 13 centers in a multicenter international cohort comparing patients with anterior circulation large vessel occlusion presenting more than 24 hours after LKW that received endovascular thrombectomy versus patients that were treated with best medical management.

A total of 153 (64%) of 240 patients with a median LKW 28.3 hours received endovascular therapy.

Researchers found that endovascular therapy was associated with a better shift in 90-day modified Rankin Scale score (mRS), higher functional independence (42% vs 10%), and lower mortality (22% vs 42%) compared to medical management. Among patients treated with endovascular thrombectomy, successful reperfusion was also associated with lower mortality, higher functionality, and overall better shift in 90d mRS.

Amrou Sarraj, MD, Department of Neurology, University of Texas at Houston Stroke Center, highlighted that endovascular thrombectomy was associated with numerically higher risk of symptomatic intracerebral hemorrhage (5.5% in EVT arm vs 0% in medical management arm, P = 0.01).

“Endovascular Thrombectomy may be effective and safe in patients with ischemic stroke and large vessel occlusion presenting beyond 24 hours from last well known,” Dr Sarraj shared with Neurology Learning Network.

Additional studies are warranted.

Reference

Sarraj, Amrou. Endovascular thrombectomy beyond 24 hours from last known well: a pooled multicenter international cohort. Presented at: International Stroke Conference 2022; February  9-1, 2022; Virtual.