Endovascular Treatment After Stroke Due to Large Vessel Occlusion for Patients Presenting Very Late From Time Last Known Well
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View abstract on PubMed
Summary
This summary is machine-generated.Endovascular treatment (EVT) for large vessel occlusion ischemic stroke is effective even beyond 16 hours. Patients presenting late may benefit from EVT, showing improved outcomes and a favorable modified Rankin Scale score shift.
Area Of Science
- Neurology
- Interventional Radiology
- Stroke Medicine
Background
- Endovascular treatment (EVT) for acute ischemic stroke due to large vessel occlusion (LVO) is typically time-limited, with a standard window of less than 16-24 hours from the last known well (LKW).
- However, some patients with slow stroke progression and robust collateral circulation may retain salvageable brain tissue beyond this conventional time window.
Purpose Of The Study
- To determine the prevalence of salvageable brain tissue in patients with LVO ischemic stroke presenting more than 16 hours after LKW.
- To investigate the efficacy of EVT in this delayed presentation cohort.
Main Methods
- A retrospective case-control study identified 150 patients with LVO ischemic stroke presenting >16 hours from LKW.
- Baseline imaging assessed ischemic core, collateral status, and perfusion parameters. Outcomes included final infarct volume, hemorrhagic transformation, and modified Rankin Scale (mRS) score at 90 days.
- Propensity score-matched analyses compared EVT versus medical management.
Main Results
- Of 150 patients, 16% received EVT. Significant salvageable tissue (penumbra) was observed in a substantial proportion.
- EVT was associated with improved odds of a favorable 90-day mRS score (0-2) and a significant mRS score shift.
- In a subgroup presenting >24 hours from LKW, EVT also showed a favorable mRS shift.
Conclusions
- This study indicates that patients with anterior circulation LVO ischemic stroke presenting late (>16 hours to 10 days) may benefit from EVT.
- The findings challenge the strict time-based eligibility criteria for EVT in selected stroke patients.
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