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Endovascular thrombectomy after 24 hours for patients with acute ischemic stroke due to large vessel occlusion: A systematic review and meta-analysis of outcomes. | LitMetric

AI Article Synopsis

Article Abstract

Objective: To evaluate the role of endovascular thrombectomy (EVT) in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24 hours).

Methods: A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24 hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.

Results: This review included 35 studies with 15,086 patients. The proportion of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24 hours was 4.78 % (95 % CI: 3.20 %-6.58 %), with a risk ratio (RR) of 0.85 (95 % CI: 0.44-1.64) compared to EVT patients treated within 24 hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73 % (95 % CI- 27.26 %, 44.64 %) with a risk ratio of 0.85 (95 % CI: 0.34, 2.09). The proportion of the 90-day mortality was 22.30 % (95 % CI: 16.12 %, 29.09 %), with a risk ratio of 1.08 (95 % CI: 0.73, 1.61). The overall proportion of intracerebral hemorrhage (ICH) was 12.23 % (95 % CI: 5.47-20.86) following EVT after 24 hours.

Conclusion: Patients treated with EVT after 24 hours have comparable safety and effectiveness to those treated within 24 hours. The outcomes suggest that EVT after 24 hours is a viable treatment option, offering similar benefits to earlier intervention.

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Source
http://dx.doi.org/10.1016/j.clineuro.2024.108610DOI Listing

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