Thrombectomy for Ischemic Stroke Beyond 24 Hours: A Meta-Analysis.

Area of Science:

• Neurology
• Interventional Cardiology
• Public Health

Background:

• Established benefits of endovascular therapy (EVT) for large vessel occlusion (LVO) stroke within 6-24 hours (DEFUSE-3, DAWN studies).
• Uncertainty exists regarding the effectiveness of EVT for ischemic stroke patients presenting beyond the 24-hour window.
• Need for comparative analysis of EVT outcomes in different time windows.

Purpose of the Study:

• To evaluate and compare the prognosis of patients undergoing EVT for ischemic stroke beyond 24 hours versus within 24 hours.
• Assess differences in functional independence, reperfusion, hemorrhage, and mortality rates between the two treatment groups.

Main Methods:

• Systematic review of PubMed, Cochrane, and Embase databases up to February 1, 2024.
• Inclusion of seven cohort studies with 6137 participants receiving EVT.
• Calculation of odds ratios (OR) with 95% confidence intervals (CI) for key outcome measures.

Main Results:

• No significant differences observed in functional independence (OR 1.06, 95% CI: 0.51-2.19).
• Similar rates of successful reperfusion (OR 1.03, 95% CI: 0.72-1.48) and intracranial hemorrhage (any: OR 0.88, 95% CI: 0.64-1.21; symptomatic: OR 0.76, 95% CI: 0.41-1.40).
• 90-day mortality rates were comparable between groups (OR 1.32, 95% CI: 0.55-3.19); trial sequential analyses were inconclusive.

Conclusions:

• EVT for ischemic stroke beyond 24 hours yields comparable outcomes to treatment within 24 hours regarding functional independence, reperfusion, hemorrhage, and mortality.
• EVT may be a viable option for patients presenting with ischemic stroke after 24 hours.
• Further randomized controlled trials and additional cohort studies are warranted to solidify these findings.