Neurology in critical care · Late thrombectomy
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
| Design | Multicentre randomised controlled trial, stopped early at prespecified interim analysis |
|---|---|
| Treatment | Mechanical thrombectomy plus standard care |
| Control | Standard care alone |
| Population | 206 patients last known well 6 to 24 hours earlier, with a mismatch between clinical deficit and infarct volume |
| Follow-up | 90 days |
| Primary endpoint | Mean score on the utility-weighted modified Rankin Scale at 90 days |
| Result | 107 patients were assigned to thrombectomy and 99 to control. Disability outcomes at 90 days were better with thrombectomy. Enrolment stopped at 31 months following a prespecified interim analysis. |
| Secondary endpoints | Functional independence at 90 days, infarct volume, symptomatic haemorrhage |
Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone.
The trial authors, in the published abstract
The clinical-imaging mismatch concept in its purest form, and the trial that abolished the six-hour ceiling for thrombectomy. Stopped early for efficacy, which tends to inflate effect estimates. Its selection criteria remain restrictive, and much of the subsequent argument has been about how far they can be relaxed.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018 Jan 4;378(1):11-21.