Endovascular therapy improved clinical outcomes among patients 6-24 hours post-ischemic stroke with collateral flow

1. Median modified Rankin Scale score at 90 days was lower in the endovascular group, indicating improved outcomes.

2. Symptomatic intracranial bleeding was more prominent in the intervention group than control.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Previous guidelines support the use of endovascular treatment for patients with anterior circulation artery-related ischemic stroke within 6 hours of symptom onset. However, there are limited studies evaluating the benefits of endovascular reperfusion in patients 6-24 hours following an ischemic stroke. This randomized controlled trial aimed to compare the safety and efficacy of endovascular treatment for patients treated 6-24 hours after an ischemic stroke. The primary outcome was the median modified Rankin Scale (mRS) score at 90 days from randomization while key secondary outcomes included functional status and stroke severity. According to study results, endovascular treatment resulted in reduced disability compared to control with similar all-cause mortality. However, the endovascular treatment group was found to have an increased incidence of symptomatic intracranial hemorrhage compared to the control group. This study was strengthened by a large sample size with individuals of all ages and comorbidities, thus increasing its validity.

Click to read the study in The Lancet

Relevant Reading: Trial of Endovascular Thrombectomy for Large Ischemic Strokes

In-depth [randomized-controlled trial]: Between Feb 2, 2018, and Jan 27, 2022, 535 patients were assessed for eligibility across 18 stroke intervention centers in the Netherlands. Included were those ≥ 18 years old with an ischemic stroke, computed tomography angiography (CTA)-confirmed anterior circulation occlusion, and a National Institutes of Health Stroke Scale (NIHSS) score ≥ 2. Altogether, 502 patients (255 in the endovascular group and 247 in the control group) were included in the intention-to-treat analysis. The primary outcome of median mRS score at 90 days was lower in the endovascular treatment group (3, interquartile range [IQR] 2-5) than in the control group (4, IQR 2-6). The endovascular treatment group also reported better clinical outcomes (adjusted odds ratio [aOR] 1.67, 95% confidence interval [CI] 1.20-2.32). Symptomatic intracranial bleeding was the most common adverse event, occurring more frequently in the intervention group compared to the control (7% vs. 2%, aOR 4.59, 95% CI 1.49-14.10). There were no differences between groups for all-cause mortality. Findings from this study suggest that endovascular treatment may be safe and effective for patients with ischemic stroke.

Image: PD

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