Enlarged therapeutic window for ischemic stroke in a real life regional experience: is it always a valid approach?

BACKGROUND

International trials suggested the efficacy of therapeutic window enlarged for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Real-life studies seem to confirm this opportunity. We aimed to evaluate the therapeutic window enlargement impact in an about 1.5 million residents region to determine if our drip-and-ship organization could ensure favorable clinical outcome and safety for patients treated more than 6 h after stroke onset.

METHODS

All AIS patients attending the Emergency Department of the only Marche region hub hospital who underwent MT were enrolled. We collected epidemiological, clinical and radiological variables. We used the National Institutes of Health Stroke Scale (NIHSS) to assess patients and calculated delta (NIHSS) as the difference between admission and discharge NIHSS scores. We examined patients undergoing MT with an onset-to-groin time (OGT) of less and greater than 6 h.

RESULTS

Delta (NIHSS) showed a statistically significant difference between patients who underwent MT within and after 6 h from symptom onset, with notable improvement in the first group. The overall prevalence of post-procedural intracranial bleeding did not significantly differ between the two groups (32.3% vs. 38.2%; p = 0.266). The risk of in-hospital deaths significantly increased among patients treated after 6 h.

CONCLUSIONS

Our results suggest satisfactory AIS outcomes even when treated several hours after the symptoms' onset, despite a significant increase in the number of in-hospital deaths. However, the better results obtained with earlier IT and MT confirm the "golden hour" concept. Our findings show that our stroke organization provides a good clinical opportunity for patients treated within an extended therapeutic window.