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Wareham J, Phan K, Renowden S, et al. A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct. Neurointervention. 2017;12(2):59-68doi: 10.5469/neuroint.2017.12.2.59.
Wareham, J., Phan, K., Renowden, S., & Mortimer, A. M. (2017). A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct. Neurointervention, 12(2), 59-68. https://doi.org/10.5469/neuroint.2017.12.2.59
Wareham, James, et al. "A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct." Neurointervention vol. 12,2 (2017): 59-68. doi: https://doi.org/10.5469/neuroint.2017.12.2.59
Wareham J, Phan K, Renowden S, Mortimer AM. A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct. Neurointervention. 2017 Sep;12(2):59-68. doi: 10.5469/neuroint.2017.12.2.59. Epub 2017 Sep 05. PMID: 28955507; PMCID: PMC5613046.
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Neurointervention. 2017 Sep;12(2):59-68. doi: 10.5469/neuroint.2017.12.2.59. Epub 2017 Sep 05.

A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct.

Neurointervention

James Wareham, Kevin Phan, Shelley Renowden, Alex M Mortimer

Affiliations

  1. Department of Neuroradiology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
  2. NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Barker Street, Sydney, NSW, 2109, Australia.

PMID: 28955507 PMCID: PMC5613046 DOI: 10.5469/neuroint.2017.12.2.59

Abstract

PURPOSE: The safety and efficacy of endovascular thrombectomy (EVT) for patients with proximal occlusive stroke presenting beyond 6 hours and selected on the basis of favorable neuroimaging remains unclear.

MATERIALS AND METHODS: A systematic search was performed from four electronic databases from their inception to Jan 2017. A meta-analysis of outcomes from studies with patients treated beyond 6 hours was compared to those treated within the established 6 hour therapeutic window in randomized trials, selected using conventional imaging methods with CT/CT angiography.

RESULTS: A total of 8 articles met inclusion criteria for the study population (a prospective single-center study, 5 retrospective single-center studies and 2 retrospective multicenter studies). These were compared to the results of three prospective trials of patients treated within 6 hours selected using CT/CT angiography. For patients treated >6 hours and <6 hours respectively, the weighted mean age was 64.7 vs. 67.0 years; the presenting NIHSS was 15.7 vs. 17.1 and the time from symptom onset to puncture was 4.0 hours vs. 15.1 hours. Weighted pooled estimates of successful recanalization (TIMI 2/3 or TICI 2b/3) and favorable outcome (mRS ≤2) were similar between both groups, 70.1% vs. 70.6%, P=0.75 and 38.9% vs. 38.4%, P=0.88 respectively. Pooled mortality measured at 3 months was 22.8% for those treated >6 hours and 12.5% for <6 hours, P<0.0001. Symptomatic intracranial hemorrhage was not significantly different (10.0% vs. 7.7%, P=0.33).

CONCLUSION: When compared to established methods of patient selection, EVT employed beyond 6 hours in those selected with imaging to exclude large core infarcts achieves similar rates of recanalization, and functional outcome but there is a significant increase in mortality despite no increase in symptomatic intracranial hemorrhage.

Keywords: Endovascular; Infarct; Perfusion; Stroke; Thrombectomy

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