Thrombectomy Can Benefit Certain Stroke Patients

Patients who were well 6 to 24 hours prior to an acute stroke and have mismatched clinical deficit severity and infarct volume benefit more from thrombectomy plus standard care than from standard care alone, according to the findings of a recent study.

The randomized controlled trial included 206 patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had been well 6 to 24 hours earlier and had a mismatch between severity of the clinical deficit and infarct volume. A total of 107 patents were assigned to thrombectomy with standard care and 99 were assigned to standard care alone. Using the modified Rankin scale, the researchers assessed disability and rate of functional independence at 90 days as the primary end points.
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At 90 days, the mean utility-weighted modified Rankin scale score was 5.5 among patients in the thrombectomy group and 3.4 among patients in the control group. Compared with the control group, the rate of functional independence at 90 days was higher among those in the thrombectomy group (13% vs 90%, respectively).

However, there were no significant differences in the rate of symptomatic intracranial hemorrhage or 90-day mortality between groups.

“Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone,” the researchers concluded.

—Melissa Weiss

Reference:

Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct [published online November 11, 2017]. N Engl J Med. doi:10.1056/NEJMoa1706442.