Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

Area of Science:

• Neuroscience
• Medical Imaging
• Interventional Neurology

Background:

• Endovascular thrombectomy has demonstrated efficacy in late-window stroke patients selected by penumbral imaging.
• The role of penumbral imaging in early-window stroke treatment (0-6 hours) remains less clear.
• CT perfusion (CTP) is utilized to identify salvageable brain tissue.

Purpose of the Study:

• To evaluate if treatment time modifies the effectiveness of endovascular reperfusion in stroke patients identified with salvageable tissue via CTP.
• To determine the impact of time to treatment on thrombectomy outcomes in the early versus late windows.

Main Methods:

• Retrospective analysis of 235 consecutive stroke patients undergoing thrombectomy.
• Comparison of demographics, clinical severity (NIHSS), recanalization rates, and infarct volumes between early and late treatment windows.
• Multivariable logistic regression to identify predictors of good 90-day functional outcome (modified Rankin Scale 0-2).

Main Results:

• The early and late treatment groups were comparable in age, NIHSS, occlusion location, initial infarct volume, and recanalization rates.
• No significant difference in favorable 90-day outcomes (mRS 0-2) was observed between the groups (P = .30).
• Age, NIHSS, recanalization, and final infarct volume were independent predictors of favorable outcome.

Conclusions:

• Penumbral imaging-based patient selection for thrombectomy is effective across both early and late time windows.
• Similar functional outcomes are achieved in early and late window patients treated with thrombectomy when selected by penumbral imaging.
• Treatment timing does not appear to modify the benefit of thrombectomy in patients selected using CTP.