Outcomes following thrombectomy for acute large vessel occlusion beyond 24 hours or with unknown time of onset

Iezzi, Zachary; Patel, Pratit; Wolfe, Jared; Tiongson, Justin; Vigilante, Nicholas; Kamen, Scott; Penckofer, Mary; Khalife, Jane; Siegler, James E.

doi:10.1016/j.jstrokecerebrovasdis.2022.106952

Cited by 8 publications

(1 citation statement)

References 27 publications

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“…Additionally, small single-center and multi-center cohort studies analyzing patients with LVO treated in the ultra extended window reported no significant improvement in outcomes associated with EVT. However, these studies are limited by their small sample size 33,34 , which often precludes more sophisticated propensity score matching or adjusted multivariable modeling, as described in studies like SELECT LATE. Other studies were only able to report outcomes between those treated in the ultra extended window against those treated within 24 hours of TLSW 35 , which are indirect comparisons.…”

Section: Discussionmentioning

confidence: 99%

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Jafri,

Dasgupta,

E. Siegler

2023

J Neurol Neuromedicine

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Endovascular thrombectomy (EVT) revolutionized the treatment for acute ischemic stroke due to large vessel occlusion (LVO). Current guidelines published by multiple academic societies recommend EVT for eligible patients who present within 24 hours of the time last seen well. However, more recent data suggests that extending this window past 24 hours produces more favorable outcomes in specific patients presenting with anterior circulation LVO. More specifically, recent observational data indicates a higher probability of functional independence, functional improvement, and long-term survival with EVT when compared to best medical management. Based on the available data, there is unclear equipoise in randomizing all patients with acute ischemic stroke due to LVO to EVT or medical management. However, for those patients with large established infarction, distal occlusions, or well beyond the 24-hour window, randomized clinical trials are called upon to determine whether there is benefit of EVT in these patient groups. In this narrative review, we will summarize the most recent data on EVT in the ultra extended window (>24 hours after time last seen normal) and discuss further considerations of this treatment.

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Section: Discussionmentioning

confidence: 99%

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Jafri,

Dasgupta,

E. Siegler

2023

J Neurol Neuromedicine

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Is time really brain in stroke therapy?: A meta-analysis of mechanical thrombectomy up to 155 h post ictus

Larcipretti,

Gomes,

Dagostin

et al. 2024

Acta Neurochir

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Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis

Schartz,

Singh,

Ellens

et al. 2024

Clinical Neurology and Neurosurgery

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Outcomes following thrombectomy for acute large vessel occlusion beyond 24 hours or with unknown time of onset

Cited by 8 publications

References 27 publications

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Is time really brain in stroke therapy?: A meta-analysis of mechanical thrombectomy up to 155 h post ictus

Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis

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Outcomes following thrombectomy for acute large vessel occlusion beyond 24 hours or with unknown time of onset

Cited by 8 publications

References 27 publications

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Is time really brain in stroke therapy?: A meta-analysis of mechanical thrombectomy up to 155 h post ictus

Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis

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Endovascular therapy versus medical management for ischemic stroke presenting beyond 24 hours: Systematic review and meta-analysis