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Mortality, functional outcome, and bleeding risk after early versus delayed thrombectomy.

Zoltan Ungvari1,2,3,4,5, János Tibor Fekete6,7, Mónika Fekete8,9

  • 1Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

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Summary

Early endovascular thrombectomy (EVT) for acute ischemic stroke significantly reduces mortality and improves functional independence within 90 days. Late EVT (6-24 hours) showed similar safety regarding symptomatic intracranial hemorrhage, supporting its use in selected patients.

Keywords:
Acute ischemic strokeEndovascular thrombectomyFunctional outcomeLarge vessel occlusionLate interventionMeta-analysisMortalityReperfusion therapyStroke outcomesSymptomatic intracranial hemorrhageTime-to-treatmentTreatment delay

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Public Health

Background:

  • Endovascular thrombectomy (EVT) is a key treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO).
  • The optimal time window for EVT remains debated, impacting clinical decision-making.

Purpose of the Study:

  • To evaluate the impact of early (≤6 hours) versus late (>6-24 hours) EVT on mortality, functional outcomes, and safety in AIS patients.
  • To provide evidence-based recommendations on EVT timing.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials and cohort studies published between 2000-2024.
  • Searched four major databases: PubMed, Web of Science, Cochrane Library, and EMBASE.
  • Analyzed pooled incidence rates, incidence rate differences (IRD), and incidence rate ratios (IRR) for symptomatic intracranial hemorrhage (sICH), mortality, and functional independence (mRS).

Main Results:

  • Early EVT (≤6h) was associated with significantly lower mortality rates (IRD -0.148, p=0.0012) and higher rates of functional independence (IRD 0.32, p<0.0001) compared to late EVT (>6-24h).
  • No significant difference in the incidence of symptomatic intracranial hemorrhage (sICH) was observed between early and late EVT groups (IRD -0.028, p=0.33).
  • Moderate to high heterogeneity was noted across outcomes.

Conclusions:

  • Treatment timing significantly influences clinical outcomes in AIS patients undergoing EVT.
  • Early EVT (≤6 hours) demonstrates superior outcomes regarding mortality and functional independence.
  • Late EVT (>6-24 hours) is a safe option for selected patients, with no increased risk of sICH, underscoring the importance of minimizing treatment delays.