Therapeutic Advances in Neurological Disorders (May 2022)

Leaving the day behind: endovascular therapy beyond 24 h in acute stroke of the anterior and posterior circulation

  • Jan C. Purrucker,
  • Peter A. Ringleb,
  • Fatih Seker,
  • Arne Potreck,
  • Simon Nagel,
  • Silvia Schönenberger,
  • Anne Berberich,
  • Ulf Neuberger,
  • Markus Möhlenbruch,
  • Charlotte Weyland

DOI
https://doi.org/10.1177/17562864221101083
Journal volume & issue
Vol. 15

Abstract

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Background: There is little evidence of endovascular therapy (EVT) being performed in acute ischemic stroke beyond 24 h, and that evidence is limited to anterior circulation stroke. Objective: To extend evidence of efficacy and safety of EVT after more than 24 h in both anterior and posterior circulation stroke. Methods: Local, prospectively collected registries were screened for patients with acute ischemic stroke and large-vessel occlusion who had received either EVT > 24 h after last-seen-well but 24LSW ) or EVT > 24 h since first (definitive) symptom recognition (EVT >24DEF ). Patients treated 24LSW , n = 16, EVT >24DEF , n = 27). EVT >24LSW patients were treated at a median of 28.7 h [interquartile range (IQR) = 27.3–32.8] after last-seen-well and 7.3 h (IQR = 2.8–14.3) after symptom recognition; EVT >24DEF patients were treated 52.5 h (IQR = 26.5–94.2) after first symptoms. Favorable outcome was achieved by 23.3% (10/43) in the EVT > 24 compared with 39.4% (886/2250) in the EVT 24, 27.9% (12/43) versus EVT 24, 41.7% (5/12) versus EVT < 24, 36.5% (92/252) p = 0.764]. Conclusion: In selected patients, EVT seems effective and safe beyond 24 h for both anterior and posterior circulation stroke.