"Thrombectomy 6 to 24 Hours after Stroke". The New England Journal of Medicine. 2017.

Clinical Question:

Does endovascular thrombectomy performed 6 to 24 hours after the onset of ischemic stroke improve outcomes in patients with a mismatch between the severity of the clinical deficit and the infarct volume?

Bottom Line:

Thrombectomy plus standard care resulted in better 90-day outcomes for disability and functional independence compared to standard care alone in patients with acute stroke who were treated 6 to 24 hours after last being known well and had a mismatch between clinical deficit and infarct volume.

Major Points:

Guidelines:

Not addressed within the wiki's content.

Design:

Multicenter, randomized, open-label trial with a Bayesian adaptive–enrichment design and blinded endpoint assessment.

Population:

Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who were last known well 6 to 24 hours prior and had a mismatch between the severity of clinical deficit and infarct volume.

Interventions:

Patients were randomized to thrombectomy plus standard care (thrombectomy group) or standard care alone (control group).

Outcomes:

The coprimary endpoints were the mean disability score on the utility-weighted modified Rankin scale at 90 days and the rate of functional independence at 90 days. Secondary endpoints included early therapeutic response, infarct volume, and recanalization rates.

Criticisms:

- Variance in baseline characteristics between groups although sensitivity analyses confirmed the benefit of thrombectomy.
- Sample size limited the power of certain subgroup analyses.
- Frequency of general anesthesia in thrombectomy cases was only 10%.

Funding:

The trial was funded by Stryker Neurovascular.

Further Reading:

Not addressed within the wiki's content.