Thrombectomy 6 to 16 Hours After Ictus Is Beneficial

A paper by Albers et al published in the NEJM suggests that many more stroke victims can be saved from disability or death if they undergo removal of thrombi obstructing their internal carotid or proximal middle cerebral artery.

182 stroke patients with clots in major vessels were enrolled in the study.  They were last known to be well between 6 and 16 hours earlier and had diffusion and perfusion MRI scans upon admission to Emergency Room. Patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion, and an initial infarct size of less than 70 ml, and a ratio of the volume of ischemic tissue on perfusion imaging to infarct volume of 1.8 or more were randomly assigned to endovascular therapy plus standard medical therapy or standard medical therapy alone. The primary outcome was the score on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at day 90.  Ninety-two of these patients had clots removed, while the remaining 90 did not. 

The study found that the 90-day death rate was lower for patients who had a thrombectomy vs. those who did not – 14 percent vs. 26 percent.   The data also indicated that more pronounced was the rate of functional independence among the thrombectomy patients – 45 percent vs. 17 percent at 90 days after the procedure.

Endovascular thrombectomy for ischemic stroke plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted.