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Is time really brain in stroke therapy?: A meta-analysis of mechanical thrombectomy up to 155 h post ictus

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Abstract

Background and objectives

Mechanical thrombectomy (MT) has been established as the gold standard of treatment for patients with Acute Ischemic Stroke (AIS) who present up to 6 h after the onset of the stroke. Recently, the DEFUSE-3 and DAWN trials established the safety of starting the MT procedure up to 16 and 24 h after the patient was last seen well, respectively. The purpose of this study is to assess the safety and functional effects of thrombectomy in individuals with AIS detected at a late stage (> 24 h).

Materials and methods

PubMed, Web of Science, Embase, and Cochrane databases were thoroughly searched for research on MT in patients in the extremely late time window after AIS. The primary outcomes were symptomatic cerebral hemorrhage, 90-day mortality, Thrombolysis in Cerebral Infarction (TICI) 2b-3, and Modified Rankin Scale (mRS) 0–2.

Results

Our study included fifteen studies involving a total of 1,221 patients who presented with AIS and an extended time window. The primary outcome of interest was the favorable functional outcome, mRS 0–2 at 90 days. The pooled proportion for this outcome was 45% (95% confidence interval 34–58%). Other outcomes included the TICI 2b or 3 (successful recanalization), which was reported in 12 studies and had a 79% incidence in the study population (95% CI 68–87%). Complications included: symptomatic intracranial hemorrhage (sICH), which revealed an incidence of 7% in the study population (95% CI 5–10%); and 90-day mortality, which reported a 27% incidence (95% CI 24–31%). In addition, we conducted a comparative analysis between endovascular treatment and standard medical therapy.

Conclusion

Our meta-analysis provides evidence that supports the need of further randomized and prospective clinical trials to better assess the effectiveness and safety of MT in these patients.

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Data availability

This meta-analysis used data from previously published studies, therefore all data and study materials are public domain. The meta-analysis authors do not have patient-level data from the various studies. Researchers interested in individual-level data from this meta-analysis should contact each study's corresponding author.

Abbreviations

AIS:

Acute Ischemic Stroke

ASPECT:

Alberta Stroke Program Early CT Score

LVO:

Large vessel occlusion

mRS:

Modified Rankin Score

MT:

Mechanical thrombectomy

NIHSS:

National Institute of Health Stroke Scale

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

PROSPERO:

International Prospective Register of Systematic Reviews

sICH:

Symptomatic intracranial hemorrhage

SMT:

Standard medical treatment

TICI:

Thrombolysis in Cerebral Infarction

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Acknowledgements

The authors would like to thank Rhanderson Cardoso, MD, for the support in conducting this research. We would also like to thank the Meta-Analysis Academy for immense support in the elaboration of this project.

Funding

This research did not receive any specific grant from any government, private, or non-profit funding source.

Author information

Authors and Affiliations

  1. School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil

    Anna Laura Lima Larcipretti

  2. Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Fernando Cotrim Gomes

  3. School of Medicine, University of the Extreme South of Santa Catarina, Criciúma, Brazil

    Caroline Serafim Dagostin

  4. Faculty of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil

    Gabriela Borges Nager

  5. Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil

    Ofonime Chantal Udoma-Udofa

  6. Department of Surgical Specialties, Neurosurgery Teaching and Assistance Unit, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil

    Julia Pereira Muniz Pontes

  7. School of Medicine, National University of Rosario, Rosario, Argentina

    Jéssica Sales de Oliveira

  8. Department of Surgery, Neurology and Neurosurgery Unit, Federal University of Goiás, Goiânia, Brazil

    Matheus de Andrade Bannach

Authors
  1. Anna Laura Lima Larcipretti
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  2. Fernando Cotrim Gomes
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  8. Matheus de Andrade Bannach
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Contributions

Conception and design of the research: A.L.L.L., M.A.B.; Acquisition of data: A.L.L.L., F.C.G., and C.S.D.; Analysis and interpretation of the data: A.L.L.L., F.C.G., and C.S.D.; Writing of manuscript: all authors; Critical revision of the manuscript for intellectual content: all authors.

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Correspondence to Matheus de Andrade Bannach.

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Larcipretti, A.L.L., Gomes, F.C., Dagostin, C.S. et al. Is time really brain in stroke therapy?: A meta-analysis of mechanical thrombectomy up to 155 h post ictus. Acta Neurochir 166, 195 (2024). https://doi.org/10.1007/s00701-024-06070-6

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