ESOC 2022 | Endovascular thrombectomy outcomes in patients presenting beyond 24 hours
Endovascular thrombectomy (EVT) is the gold standard treatment approach for acute ischemic stroke, with rigorous clinical trial data supporting its efficacy in appropriately selected patients, up to 24 hours from symptom onset. However, there has been very little evaluation of the safety and efficacy of EVT more than 24 hours from symptom onset. Permesh Singh Dhillon, BMedSci, BMBS, FRCR, Nottingham University Hospitals NHS Trust, Nottingham, UK, shares the findings from a propensity score matched cohort study investigating the safety and functional outcomes of EVT in the very late time window. Over 100 patients presenting beyond 24 hours who underwent EVT after advanced imaging based selection were compared with patients with EVT treatment initiation between 6 and 24 hours. Overall, safety and functional outcomes in those receiving EVT after more than 24 hours were comparable to those treated in the earlier time window. Dr Dhillon notes the need to consider brain tissue viability more heavily than time since symptom onset when determining EVT eligibility. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.
Transcript (edited for clarity)
Essentially, as we know, endovascular thrombectomy is effective in up to 24 hours, but particularly in the late time window between six to 24 hours for patients who are carefully selected, based on perfusion or DWI imaging. Patients who’ve got a good infarct core to penumbra ratio. These patients are eligible to have endovascular thrombectomy. However, we have a special group of patients who present later than 24 hours...
Essentially, as we know, endovascular thrombectomy is effective in up to 24 hours, but particularly in the late time window between six to 24 hours for patients who are carefully selected, based on perfusion or DWI imaging. Patients who’ve got a good infarct core to penumbra ratio. These patients are eligible to have endovascular thrombectomy. However, we have a special group of patients who present later than 24 hours. And we have little data on this, as to what the patient characteristics are and their outcomes.
There have only been a handful of studies so far, or case series that have looked into this, so what we aimed to do was we used a national registry in the United Kingdom to look at the outcomes of these patients. We had just over 100 patients in this cohort, the largest to date that we’re aware of. And we found that when you compare them to the cohort of patients who present between six to 24 hours, the outcomes are actually very similar. That, hopefully in some respects, provides some level of confidence to say that we could potentially still treat patients beyond 24 hours with endovascular thrombectomy if we think they’re suitable to have it, if they’re still eligible. I think we should move away from the time concept and just treat patients as long as they have viable brain tissue to save.
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