Deans' stroke musings: Outcomes of endovascular treatment for acute large vessel ischemic stroke more than 6 hours after symptom onset

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, September 26, 2017

Outcomes of endovascular treatment for acute large vessel ischemic stroke more than 6 hours after symptom onset

This still leaves the question of what is the treatment for those that don't meet this timeframe.

Outcomes of endovascular treatment for acute large vessel ischemic stroke more than 6 hours after symptom onset

Motyer R, Kok H, Asadi H, O'Hare A, Brennan P, Power S, Looby S, Nicholson P, Williams D, Murphy S, Hill M, Goyal M, McManus J, O'Brien P, Thornton J; Journal of Internal Medicine (Sep 2017)

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BACKGROUND AND OBJECTIVES Benefit from endovascular thrombectomy (EVT) for large vessel occlusion (LVO) acute ischemic stroke (AIS) is well demonstrated. Furthermore, emerging evidence supports efficacy in appropriately selected patients treated beyond current recommendations of 6 hours. We evaluated clinical outcomes in patients undergoing late EVT at our institution.
METHODS Retrospective review of prospectively collected clinical database on 355 patients who underwent EVT for LVO AIS. Data collected consisted of patient demographics, radiological findings and outcome details. Outcomes, including 90-day functional status, recanalization, symptomatic intracranial hemorrhage (sICH) and 90-day mortality, for patients undergoing EVT<6 hours,>6 hours and>7.3 hours were compared.
RESULTS 355 patients underwent EVT for LVO AIS at our institution during the review period, with 74 (21%) patients treated ≥6 hours from symptom onset. Successful recanalization was achieved in 285 (80%) patients, with 228 (81%) achieving a mTICI ≥2b in the<6 hour group, and 57 (77%) in the>6 hour group (p=0.429). 90-day functional independence (mRS 0-2) was achieved in 162 (46%) patients, with 130 (46%) achieving a mRS of 0-2 in the<6 hour group, and 32 (43%) in the>6 hour group (p=0.643). No significant differences were found in rates of sICH or 90-day mortality. No significant differences in functional independence, recanalization rates, sICH, or mortality were identified in patients treated with EVT>7.3 hours compared to<7.3 hours.
CONCLUSIONS In appropriately selected patients, EVT>6 hours was associated with comparable outcomes to those treated<6 hours. These data support a physiological approach to patient selection. This article is protected by copyright. All rights reserved.