Beyond 6 Hours: With MR Selection, Improved Outcomes after Successful
Late Thrombectomy in Anterior Circulation Large Vessel Occlusion Stroke
Abstract
Abstract Purpose The benefit of thrombectomy among patients with
anterior circulation large vessel occlusion (LVO) stroke is unclear
beyond 6 hours. Here we sought to ascertain whether or not successful
thrombectomy is beneficial when performed in MR-selected patients more
than 6 hours after stroke onset. Methods A cohort of 30 LVO patients who
underwent thrombectomy after MR selection between 11/1/2012 until
5/15/2015 was studied. Patients were selected for thrombectomy based on
small diffusion-restricted core volume at presentation. Patients with
decision to treat later than 6 hours from symptom onset and who achieved
TICI≥2B recanalization (n=21) were compared against patients with failed
thrombectomy (TICI<2B) at any time (n=9). Outcomes measures
were final infarct volume and disposition from hospital. Results The
median time from symptom onset to access for the successful late
thrombectomy group was 10.6 h (IQR 7.8 – 14.4). Compared with the
failed intervention group, patients with successful late thrombectomy
had smaller median final infarct volume (20 mL v. 53 mL, p = 0.045),
less median infarct growth (+4 mL v. +43 mL, p = 0.036), and were more
likely to be discharged home or to rehab (66.7% v. 22.2%, OR 7.14
[95% CI: 1.26 – 34.5]). Conclusion Late MR-selected LVO patients
had smaller final core volumes and superior in-hospital clinical
outcomes after successful thrombectomy compared with similar patients
who had failed or incomplete thrombectomy. Favorable outcomes were
achieved well beyond 6 hours.