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

Authors

Muhammad Shakir, University of Missouri, United StatesFollow
Hammad Atif Irshad, Aga Khan UniversityFollow
Bilal Ahmed Lodhi, Aga Khan UniversityFollow
Zuhaib Ali, Aga Khan UniversityFollow
Fizza Zubair, Aga Khan UniversityFollow
Muhammad Umar Mahar, Aga Khan UniversityFollow
Illiyun Banani, Aga Khan UniversityFollow
Amna Wajahat, Fazaia Medical College, Pakistan
Inamullah Khan, University of Missouri, United States
Farhan Siddiq, University of Missouri, United States

Document Type

Article

Department

Medical College Pakistan

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.

Comments

Issue and pagination are not provided by the author/publisher.

Publication (Name of Journal)

Clinical Neurology and Neurosurgery

DOI

10.1016/j.clineuro.2024.108610

Recommended Citation

Shakir, M., Irshad, H. A., Lodhi, B. A., Ali, Z., Zubair, F., Mahar, M. U., Banani, I., Wajahat, A., Khan, I., Siddiq, F. (2024). Endovascular thrombectomy after 24 hours for patients with acute ischemic stroke due to large vessel occlusion: A systematic review and meta-analysis of outcomes. Clinical Neurology and Neurosurgery, 247.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_mc/486