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

Hao-Tse Chiu1,2, Po-Huang Chen3, Yen-Yue Lin1,2

  • 1Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, National Defense Medical Center, No. 168, Zhongxing Rd., Longtan Dist., Taoyuan 325208, Taiwan.

Life (Basel, Switzerland)
|April 26, 2025
PubMed
Summary

Endovascular therapy for ischemic stroke beyond 24 hours shows similar outcomes to treatment within 24 hours. This suggests potential benefits for extended treatment windows in stroke patients, though more research is needed.

Keywords:
acute ischemic strokeendovascular thrombectomylarge vessel occlusionlow NIHSS scoremeta-analysis

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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.