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

The DEFUSE-3 and DAWN studies established the benefits of endovascular therapy for patients with stroke with large vessel occlusion in a 6-24 h time window. However, the effectiveness of endovascular therapy performed beyond 24 h remains uncertain. The purpose of this meta-analysis is to evaluate the difference in prognosis between thrombectomies performed beyond 24 h and within 24 h from ischemic stroke onset.

A systematic review was conducted using the PubMed, Cochrane, and Embase databases from database inception until 1 February 2024. Odds ratios with 95% confidence intervals were calculated.

This study included seven cohort articles involving 6137 participants who received endovascular therapy, with 395 patients in the beyond 24 h group and the remainder in the within 24 h group. The results for functional independence, successful reperfusion, any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 90-day mortality rates were similar between the two groups, with odds ratios of 1.06 (95% confidence interval: 0.51-2.19), 1.03 (0.72-1.48), 0.88 (0.64-1.21), 0.76 (0.41-1.40), and 1.32 (0.55-3.19), respectively. Furthermore, all trial sequential analysis results were inconclusive.

Functional independence, successful reperfusion, mortality, and intracranial hemorrhage rates did not significantly differ between endovascular therapies performed beyond and within 24 h from ischemic stroke onset. Therefore, endovascular therapy may be considered for patients experiencing ischemic stroke for more than 24 h. However, randomized controlled trials and more cohort studies are needed to confirm these conclusions.