The efficacy and safety of endovascular treatment for acute ischemic progressive stroke beyond 24 h

OBJECTIVE: To explore the efficacy and safety of endovascular thrombectomy (EVT) for progressive stroke with large vessel occlusion (LVO) beyond 24 h. METHODS: In this retrospective cohort study, 122 Patients with progressive stroke due to LVO beyond 24 h were selected with Non-Contrast Computed Tomography (NCCT) head, and assigned to the EVT group (n = 61) and the Standard Medical Therapies (SMT) group (n = 61). The proportion of 90-day modified Rankin Scale (mRS) of 0-2, mRS score at discharge and 90-day mRS score, symptomatic intracranial hemorrhage (sICH) and mortality were compared between the two groups. Multivariate regression analysis was performed to assess whether EVT was an independent predictor of clinical outcomes. RESULTS: No statistically significant differences were observed between the two groups in terms of age, sex distribution, history of hypertension, diabetes, hyperlipidemia, atrial fibrillation, smoking, drinking, National Institutes of Health Stroke Scale (NIHSS) and Alberta Stroke Program Early CT (ASPECTS) scores at admission and at neurological deterioration, proportion of patients receiving intravenous thrombolysis (IVT), arterial occlusion site, discharge disposition or TOAST classification (all P > 0.05). The recanalization rate (modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b-3) of EVT reached 95.1%. Compared with SMT, the proportion of 90-day mRS of 0-2 in the EVT group was higher (60.66% vs. 40.98%, P = 0.046), while they had significantly lower mRS score at discharge (P = 0.003) and 90-day (P = 0.014). Multivariate logistic regression analysis demonstrated that the EVT group was the independent predictor of favorable 90-day outcome (mRS 0-2) (adjusted Odds Ratio (aOR) = 2.29, 95%CI: 1.05-5.12, P = 0.04). In addition, there was no statistical difference in the proportion of sICH (P = 0.119) and 90-day mortality between the two groups (P = 0.178). CONCLUSION: The study highlights the safety and effectiveness of EVT in LVO for progressive strokes beyond 24 h based on NCCT head. However, further high quality randomized trials are needed to confirm this finding.