Objective:

To compare outcome of endovascular thrombectomy (EVT) patients treated between 6-24 hour time window (within standard guideline window) and beyond 24 hour time window

Background:

Trials have shown benefit of EVT in carefully selected patients based on perfusion study up to 24 hours. In some clinical scenarios, perfusion studies are being used to identify patients beyond 24 hours who would still benefit from EVT based on favorable penumbra tissue. More data has emerged to use circulation- physiology based criteria rather than time based criteria to select patients for EVT.

Design/Methods:

Data from a large 41-hosptial system stroke registry included acute ischemic stroke patients receiving EVT between January 2019 and August 2022. Those who had last known well to groin puncture time (LKW-to-GP) less than 6 hours or were treated with IV thrombolytic were excluded. Patients who received EVT between six and 24 hours from LKW were compared to those who received EVT beyond 24 hours from LKW with regard to patient demographics, medical history, stroke severity at admission, hemorrhagic complications, reperfusion scores and discharge disposition. Pearson’s Chi-square, Fisher’s exact, t-tests and non-parametric tests were used.

Results:

Of 1,291 patients included in the analysis, 14.4% (n=186) received EVT beyond 24 hours and 85.6% (n=1,105) received EVT between 6 and 24 hours. There were no significant differences in stroke severity or patient demographics. Patients treated beyond 24 hours had a lower prevalence of previous stroke (14.0% vs 20.9%, p=0.04). No other significant differences in medical history were found. There were no significant differences in TICI 2b or III recanalization scores, discharge disposition, or hemorrhagic complications.

Conclusions:

Endovascular thrombectomy beyond 24 hours could provide similar favorable outcome without additional complications in carefully selected patients of stroke with large vessel occlusion.