Efficacy and safety of endovascular thrombectomy for large vessel occlusion stroke beyond 24 hours from time last known well: a systematic review and meta-analysis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-03-27 DOI:10.1016/j.wneu.2025.123943

Jian Wu, Wen-Ya Gao, Min-Gang Liang, Fu-Li Yan, Ming-Fei Yang, Bin Liu

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Abstract

Background: Endovascular thrombectomy (EVT) has become the standard of care for selected patients with acute ischemic stroke within 24 hours of symptom onset. However, the efficacy and safety of EVT for stroke presenting beyond 24 hours is undetermined.

Methods: We performed a systematic review and meta-analysis to examine the outcomes of EVT in patients with acute ischemic stroke beyond 24 hours from onset. The primary outcome was 90-day functional independence defined as the modified Rankin Scale score of 0-2 (mRS 0-2). Secondary outcomes included successful reperfusion defined as Thrombolysis in Cerebral Infarction 2b-3 (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.

Results: Six studies enrolled a total of 5,868 patients to compare the prognosis of EVT for stroke patients treated beyond 24 hours versus within 6-24 hours. The study results indicated that there was no difference in the rate of successful reperfusion (RR 1.00, 95% CI 0.94-1.06, P = 0.96) and sICH (RR 0.63, 95% CI 0.35-1.16, P = 0.14) between the two groups of patients who underwent EVT at different times. Four studies involving 707 patients compared the outcomes of EVT versus best medical treatment (BMT), including thrombolysis, for stroke patients treated beyond 24 hours. Compared to patients receiving BMT, those undergoing EVT were more likely to achieve 90-day functional independence (RR 1.96, 95% CI 1.27-3.01, P < 0.05) and a lower risk of sICH (RR 3.52, 95% CI 1.11-11.20, P = 0.03), with no significant difference in 90-day mortality rates (RR 0.86, 95% CI 0.58-1.28, P = 0.46).

Conclusions: Our study found that the EVT time window did not significantly affect TICI 2b-3 and sICH, and EVT showed better therapeutic effects than BMT for stroke patients beyond 24 hours. Specifically, patients who underwent EVT beyond 24 hours had a higher proportion of functional independence at 90 days and a lower risk of sICH. Therefore, EVT remains an effective treatment option for patients with large vessel ischemic stroke beyond the traditional 24-hour time window.

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血管内取栓术治疗大血管闭塞性卒中超过24小时的疗效和安全性：一项系统综述和荟萃分析

背景：血管内血栓切除术（EVT）已成为急性缺血性卒中患者症状出现24小时内的标准治疗方法。然而，EVT治疗24小时以上脑卒中的有效性和安全性尚不确定。方法：我们进行了一项系统回顾和荟萃分析，以检查发病24小时以上急性缺血性卒中患者EVT的结果。主要终点为90天功能独立性，定义为修改后的Rankin量表评分0-2 （mRS 0-2）。次要结局包括成功再灌注，定义为脑梗死2b-3 （TICI 2b-3）溶栓，症状性颅内出血（sICH）和90天死亡率。结果：6项研究共纳入5,868例患者，比较EVT治疗超过24小时与6-24小时内卒中患者的预后。研究结果显示，两组患者在不同时间行EVT的再灌注成功率（RR 1.00, 95% CI 0.94 ~ 1.06, P = 0.96）和sICH （RR 0.63, 95% CI 0.35 ~ 1.16, P = 0.14）差异无统计学意义。涉及707例患者的四项研究比较了EVT与最佳药物治疗（BMT）（包括溶栓）对治疗超过24小时的卒中患者的结果。与接受BMT的患者相比，接受EVT的患者更有可能实现90天功能独立（RR 1.96, 95% CI 1.27 ~ 3.01, P < 0.05），更低的sICH风险（RR 3.52, 95% CI 1.11 ~ 11.20, P = 0.03）， 90天死亡率无显著差异（RR 0.86, 95% CI 0.58 ~ 1.28, P = 0.46）。结论：我们的研究发现EVT时间窗对TICI 2b-3和sICH无显著影响，EVT对24小时以上脑卒中患者的治疗效果优于BMT。具体来说，接受EVT超过24小时的患者在90天的功能独立比例更高，sICH的风险更低。因此，EVT仍然是大血管缺血性脑卒中患者在传统24小时时间窗之外的有效治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS