Expanding the Window to Use Mechanical Thrombectomy, Treat Ischemic Stroke: Gabor Toth, MD

WATCH TIME: 6 minutes

"With the advent of modern imaging modalities, I always thought that if we can estimate the penumbra and the core, then why do we have to stop at 24 hours?"

In the stroke field, the words “golden hour” refers to the first hour following stroke, otherwise considered the most optimal time, resulting in improved survival and better long-term outcomes. Over the years, with advances in treatment, the possibilities of treating patients in later windows has expanded. At the 2023 International Stroke Conference (ISC), held February 8-10 in Dallas, Texas, investigators from Cleveland Clinic presented data on the safety and efficacy of endovascular stroke therapy—mechanical thrombectomy (MT)—in the late window beyond 24 hours.

Led by Gabor Toth, MD, trial outcomes included intracerebral hemorrhage, procedural complications, number of passes, successful recanalization, National Institutes of Health Stroke Severity scale, and change in modified Rankin Scale at 90 days. The study enrolled 39 patients, nearly half (48.7%) of which had M1 occlusion. At the conclusion of the study, 95% of cases had no complications, and successful revascularization was achieved in 87% of the cohort.

All told, clinical outcomes of MT beyond 24 hours were similar to those seen in larger MT trials within 24 hours in patients with favorable imaging profiles, especially those with anterior circulation occlusions. Following the meeting, NeurologyLive^® sat down with Toth to discuss the reasons for the trial, along with the topline findings the clinical community should be aware of. Toth, a vascular and interventional neurologist at Cleveland Clinic, provided perspective on expanding capabilities of treating stroke past the 24-hour window, and why clinicians should still seek to provide that care, even after initially believing it might be too late.

Click here for more coverage of ISC 2023.

REFERENCE
1. Pandhi A, Chandra R, Abdulrazzak MA, et al. Mechanical thrombectomy beyond 24 hours. Presented at: 2023 International Stroke Conference; February 8-10; Dallas, TX. Abstract 45