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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Neurol
2018 ; 14
(3
): 407-412
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Mechanical Thrombectomy in Strokes with Large-Vessel Occlusion Beyond 6 Hours: A
Pooled Analysis of Randomized Trials
#MMPMID29971982
Vidale S
; Longoni M
; Valvassori L
; Agostoni E
J Clin Neurol
2018[Jul]; 14
(3
): 407-412
PMID29971982
show ga
BACKGROUND AND PURPOSE: Mechanical thrombectomy with or without intravenous
thrombolysis is indicated in the acute treatment of ischemic strokes caused by an
emergent large-vessel occlusion (ELVO) within 6 hours from symptom onset.
However, a significant proportion of patients are referred to comprehensive
stroke centers beyond this therapeutic time window. This study performed a pooled
analysis of data from trials in which mechanical thrombectomy was performed
beyond 6 hours from symptom onset. METHODS: We searched for randomized controlled
trials that compared mechanical thrombectomy with the best medical treatment
beyond 6 hours for ischemic strokes due to ELVO and reported on between 1990 and
April 2018. The intervention group comprised patients treated with mechanical
thrombectomy. Statistical analysis was conducted while pooling data and analyzing
fixed- or random-effects models as appropriate. RESULTS: Four trials involving
518 stroke patients met the eligibility criteria. There were 267 strokes treated
with mechanical thrombectomy, with a median time of 10.8 hours between when the
patient was last known to be well to randomization. We observed a significant
difference between groups concerning the rate of functional independence at 90
days from stroke, with an absolute difference of 27.5% (odds ratio=3.33, 95%
CI=1.81-6.12, p<0.001) and good recanalization (odds ratio=13.17, 95%
CI=4.17-41.60, p<0.001) favoring the intervention group. CONCLUSIONS: This
meta-analysis confirms the efficacy of mechanical thrombectomy in selected
ischemic stroke patients beyond 6 hours from symptom onset. The selection is
mainly based on the limited core infarct detected by emergent assessment using
neuroimaging techniques.