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Abstract Details

Endovascular Thrombectomy Beyond 24 Hours from Stroke Onset: A Systematic Review and Meta-Analysis
Cerebrovascular Disease and Interventional Neurology
S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (1:00 PM-1:12 PM)
001
Trials have demonstrated the benefit of EVT up to 24-hours after acute ischemic stroke (AIS) onset. Recently, real-world observational studies reported that EVT was effective and safe beyond 24-h from AIS onset with comparable outcomes to EVT within 24-h. 

To assess the safety and efficacy of endovascular thrombectomy (EVT) >24-h and compare clinical outcomes with patients treated <24-h.

A systematic search was performed in MEDLINE and EMBASE for studies published from inception to July 2022. Studies including patients with AIS who received EVT beyond 24-h from stroke onset were selected. We also included patients treated with EVT (>24-h and <24-h) from our institutional retrospective data. Outcomes of interest included functional independence (90-day mRS 0-2), successful recanalization (mTICI 2b-3), symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days. First, a single-arm meta-analysis (MA) of proportions was conducted for studies with EVT >24-h. Then, we performed a comparative MA between the <24-h and >24-h groups to calculate pooled odds ratios (OR) for each outcome. Statistical heterogeneity across studies was assessed with I2 statistics.

Five studies with 298 patients treated >24-h were included. Functional independence rate was 39% (95%CI 27–54%; I2=68%) and successful recanalization rate was 79% (95%CI 75–83%; I2=0%). Mortality and sICH rates were 25% (95%CI 20–30%; I2=0%) and 6% (95%CI 4–9%; I2=0%), respectively. We included 3272 patients (>24-h = 179; <24-h = 3093) in the comparative analysis. There was no significant difference in functional independence (OR 0.76; 95%CI 0.41–1.32), successful recanalization (OR 0.6; 95%CI 0.44–1.0), and mortality (OR 1.18; 95%CI 0.7–1.9) rates between patients who underwent EVT <24-h versus >24-h.

Our findings prove that EVT beyond 24-h is safe and effective. Also, this MA did not demonstrate a significant difference between EVT beyond and within 24-h from stroke onset regarding functional independence, successful recanalization, and mortality. 
Authors/Disclosures
Aaron Eduardo Rodriguez-Calienes (University of Iowa Hospitals and Clinics)
PRESENTER
Dr. Rodriguez-Calienes has nothing to disclose.
Juan A. Vivanco-Suarez, MD Mr. Vivanco-Suarez has nothing to disclose.
Milagros Galecio-Castillo, MD (University of Iowa Hospitals and Clinics) Dr. Galecio-Castillo has nothing to disclose.
Cynthia Zevallos Cynthia Zevallos has nothing to disclose.
Marco Moises Malaga, MD (University of California in San Francisco) Mr. Malaga has nothing to disclose.
Mudassir Farooqui, MD Dr. Farooqui has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa) Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.