Stent retrievers effective for stroke treatment after 6 hours in real world

In a real-world population, treatment of acute ischemic stroke with stent-retriever thrombectomy conferred good outcomes in patients treated after 6 hours of stroke onset, according to data presented at the Society of NeuroInterventional Surgery Annual Meeting.

As Cardiology Today’s Intervention previously reported, the DAWN and DEFUSE 3 trials showed that stent-retriever thrombectomy could be effective after 6 hours in randomized controlled trial populations, but the issue had not been studied in real-world populations.

Maxim Mokin, MD, a neurointerventionalist at Tampa General Hospital, Florida, and colleagues analyzed 830 patients with acute ischemic stroke from the North American Solitaire Stent-Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries, of whom 32.7% were treated after arriving more than 6 hours after symptom onset.

Patients from the NASA registry were treated with the Solitaire stent retriever (Medtronic) and patients from the TRACK registry were treated with the Trevo stent retriever (Stryker).

Compared with those who arrived within 6 hours, those who arrived after 6 hours were similar in age, cerebrovascular risk factors, use of balloon-guide catheter (P = .12), use of continuous aspiration (P = .15) and use of general anesthesia (P = .52), according to the researchers.

Successful recanalization, defined as Thrombolysis in Cerebral Infarction grade 2b/3, occurred in 79.4% of those treated in less than 6 hours, in 75.6% of those treated from 6 to 16 hours and 85% of those treated from 16 to 24 hours (P = .04), according to the researchers.

Good clinical outcomes, defined as a modified Rankin Scale score of 0 to 2, were observed in 48.2% of those treated in less than 6 hours, 46.2% of those treated from 6 to 16 hours and 38.9% of those treated from 16 to 24 hours (P = .8), Mokin and colleagues wrote in an abstract.

There were similar rates of mortality (20.6% vs. 21.6% vs. 33.3%; P = .6) and intracerebral hemorrhage (8% vs. 11.02% vs. 5%; P = .5) between the less than 6-hour group, the 6- to 16-hour group and the 16- to 24-hour group, respectively, according to the researchers.

“The study’s results are promising because it shows us that a wider range of patients are eligible for endovascular therapy,” Mokin said in a press release. “Patients who may not fit the criteria of randomized clinical trials or current guidelines can still experience positive outcomes with a thrombectomy.” – by Erik Swain

Reference:

Mokin M, et al. Real-world stent retriever thrombectomy for acute ischemic stroke beyond 6 hours of onset: Analysis of the combined NASA and TRACK registries. Presented at: Society of NeuroInterventional Surgery Annual Meeting; July 23-26, 2018; San Francisco.

Disclosure: Mokin reports he has financial ties with Canon Medical.