University of South Florida, Tampa, Florida, USA.
Baptist Health System, Louisville, Kentucky, USA.
J Neurointerv Surg. 2019 Apr;11(4):334-337. doi: 10.1136/neurintsurg-2018-014272. Epub 2018 Sep 15.
The DEFUSE 3 and DAWN trials have shown the benefit of thrombectomy beyond 6 hours of stroke symptom onset in carefully selected patients.
To evaluate the real-world outcomes of stent retriever thrombectomy beyond 6 hours of stroke onset using combined individual patient data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries.
Pooled analysis of individual patient data of all cases of anterior circulation acute ischemic stroke (AIS) from NASA and TRACK was performed to compare outcomes of patients presenting within the first hours 6 or beyond 6 hours of stroke symptom onset.
Of 830 patients with anterior circulation AIS from the NASA and TRACK registries, 32.7% (271 patients) underwent thrombectomy beyond the first 6 hours of symptom onset. The rates of good clinical outcome (modified Rankin scale score of 0-2 at 90 days), mortality, and symptomatic intracranial hemorrhage were similar: 48.1%, 20.6%, and 8.0% within 0-6 hours, 46.2%, 21.6%, and 10.9% within 6-16 hours, and 38.9%, 33.3%, and 5% within 16-24 hours (p=0.8, 0.6, and 0.5, respectively). The rates of successful recanalization (Thrombolysis in Cerebral Infarction 2b/3) were 79.4% in patients with stroke within 0-6 hours, 72.6% within 6-16 hours, and 85.0% within 16-24 hours (p=0.04).
Real-world experience with patients with anterior circulation AIS treated with the Solitaire and Trevo thrombectomy devices beyond the first 6 hours of symptom onset proved to be equally safe and effective as for patients with symptom onset within the first 6 hours.
DEFUSE 3 和 DAWN 试验表明，在精心挑选的患者中，血管内取栓术在卒中症状发作后 6 小时以上仍然有效。
使用北美 Solitaire 支架取栓急性卒中（NASA）和 Trevo 支架取栓急性卒中（TRACK）注册研究的个体患者数据进行联合分析，评估支架取栓术治疗卒中发作后 6 小时以上患者的真实世界结局。
对 NASA 和 TRACK 注册研究中所有前循环急性缺血性卒中（AIS）患者的个体患者数据进行汇总分析，比较症状发作后 6 小时内和 6 小时以上患者的结局。
在 NASA 和 TRACK 注册研究的 830 例前循环 AIS 患者中，32.7%（271 例）在症状发作后 6 小时内进行了取栓术。在 0-6 小时内，良好临床结局（90 天改良 Rankin 量表评分为 0-2 分）、死亡率和症状性颅内出血的发生率分别为 48.1%、20.6%和 8.0%；在 6-16 小时内，分别为 46.2%、21.6%和 10.9%；在 16-24 小时内，分别为 38.9%、33.3%和 5%（p=0.8、0.6 和 0.5）。在症状发作 0-6 小时内，血管再通率（血栓切除术溶栓分级 2b/3）为 79.4%，在症状发作 6-16 小时内为 72.6%，在症状发作 16-24 小时内为 85.0%（p=0.04）。
在前循环 AIS 患者中使用 Solitaire 和 Trevo 取栓装置进行治疗的真实世界经验表明，对于症状发作后 6 小时以上的患者，该治疗方法与症状发作后 6 小时内的患者一样安全有效。
