Noncontrast CT Selected Thrombectomy vs Medical Management for Late-Window Anterior Large Vessel Occlusion

Abstract

Background and ObjectivesThere is uncertainty whether patients with large vessel occlusion (LVO) presenting in the late 6-hour to 24-hour time window can be selected for endovascular therapy (EVT) by noncontrast CT (NCCT) and CT angiography (CTA) for LVO detection. We evaluated the clinical outcomes of patients selected for EVT by NCCT compared with those medically managed in the extended time window. MethodsThis multinational cohort study was conducted at 66 sites across 10 countries. Consecutive patients with proximal anterior LVO stroke selected for EVT by NCCT or medically managed and presenting within 6-24 hours of time last seen well (TSLW) from January 2014 to May 2022 were included. The primary end point was the 90-day ordinal shift in the modified Rankin Scale (mRS) score. Inverse probability treatment weighting (IPTW) and multivariable methods were used.

CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion

“…In the absence of randomized clinical trial data that would establish the efficacy of EVT in complex clinical scenarios, and given the high proportion of patients treated beyond current guideline criteria, 24 , 25 , 26 a more precise estimate of favorable outcomes with EVT for late window patients with LVO is needed. We modeled outcomes associated with EVT versus BMM across a large, heterogeneous cohort to predict a favorable response to treatment using a pragmatic numerical scale.…”