Early Clot-Removal Surgery Means Less Post-Stroke Disability

Following a stroke, the sooner a patient undergoes clot-busting endovascular thrombectomy, the better their outcomes are, in terms of severity of disability.

The sooner a stroke patient enters surgery to remove a blood clot, the better their outcomes are, in terms of disability, following their stroke, according to findings published in JAMA.

A multifaceted team of global researchers analyzed five trials, enrolling almost 1,300 patients, across 89 international sites, involving stent retrievers or other second-generation devices in order to characterize the period in which clot-busting endovascular thrombectomy is beneficial. Additionally, the investigators wanted to explore the extent to which treatment delay is related to any functional outcomes, mortality, and symptomatic intracranial hemorrhage.

The researchers noted that endovascular thrombectomy with second-generation devices is valuable for patients with stroke because of the intracranial large vessel occlusions. Plus, they wrote, defining the association of treatment time with outcomes could help guide the implementation.

At three months after treatment with endovascular thrombectomy plus clot-dissolving agents, patients demonstrated less disability than their single-therapy counterparts, the study authors determined. The ideal time to perform this dual therapy was within two hours from symptom onset, and the affects became non significant, the researchers said, after about seven hours.

The researchers wrote that after those estimated seven hours, “functional outcomes were better the sooner after symptom onset that endovascular reperfusion was achieved, emphasizing the importance of programs to enhance patient awareness, out of hospital care, and in hospital management to shorten symptom onset to treatment times.”

There were about 400 patients who achieved substantial reperfusion with endovascular thrombectomy, a press release outlined. The authors explained that each delay by one hour due to reperfusion was linked to more significant disability and less functional independence; however, they noted there was no change in mortality.

“The results of this study reinforce guideline recommendations to pursue endovascular treatment when arterial puncture can be initiated within 6 hours of symptom onset, and provide evidence that potentially supports strengthening of recommendations for treatment from six through 7.3 hours after symptom onset,” the study authors concluded.

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