Late thrombectomy for ischaemic stroke

Abstract

Patients with ischaemic stroke tend to delay seeking professional help compared with patients with acute myocardial infarction with ST elevation (STEMI). Moreover, for patients with STEMI, a diagnosis of ongoing ischaemia can be made with an electrocardiogram in the ambulance. The situation is vastly different for a patient who has had a stroke. Those with cortical infarcts—the case for most patients—are often not aware of their acute deficit, or they cannot communicate because of language problems. Moreover, patients with cerebral ischaemia do not have pain, as patients with STEMI do. They also typically do not wake up when a stroke occurs during sleep. Notification of the stroke to emergency services often depends on the alertness of partners and bystanders, and it should not be surprising that patients have delays in presenting to the emergency room, typically 3–4 h later than patients with a STEMI. 1 Al'Aref SJ Wong SC Swaminathan RV et al. Analysis of reperfusion time trends in patients with ST-elevation myocardial infarction across New York State from 2004 to 2012. Int J Cardiol. 2017; 232: 140-146 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 2 de Havenon A Alexander MD Nogueira RG et al. Duration of symptomatic stroke and successful reperfusion with endovascular thrombectomy for anterior circulation large vessel occlusive stroke. J Neurointerv Surg. 2021; 01 (neurintsurg-2020-016961.) Google Scholar In patients arriving after more than 6 h from onset, diagnosis of ongoing ischaemia caused by intracranial large vessel occlusion has to be made with CT angiography and perfusion imaging, which further adds to the delay. Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysisThese findings strengthen the evidence for benefit of endovascular thrombectomy in patients with evidence of reversible cerebral ischaemia across the 6–24 h time window and are relevant to clinical practice. Our findings suggest that in these patients, thrombectomy should not be withheld on the basis of mode of presentation or of the point in time of presentation within the 6–24 h time window. Full-Text PDF