Receiving a thrombectomy to remove a blood clot up to 16 hours after stroke onset may benefit a broad range of patients who have evidence of salvageable brain tissue, according to findings from the DEFUSE 3 trial.1
Results showed that the procedure benefited very old as well as younger patients, those with mild to severe stroke, and those with internal carotid artery (ICA) or middle cerebral artery (MCA) strokes. Results also suggested that both CT and MRI can be used to select patients for thrombectomy, with no significant difference in outcomes. The study was published in JAMA Neurology.1
“Endovascular therapy should not be withheld because of old age, mild symptoms, or late presentation in patients with large-vessel strokes and salvageable tissue on computed tomography or magnetic resonance imaging,” wrote first author Maarten Lansberg, MD, PhD, of Stanford University School of Medicine (Stanford, CA), and colleagues.
Studies have established the efficacy of thrombectomy for treating ischemic stroke within six hours of onset. Results from both the DAWN trial and the DEFUSE 3 trials extended this time window for certain patients.2,3
That led the American Heart Association/American Stroke Association to revise their guidelines to recommend thrombectomy up to 16 hours after stroke onset (high quality evidence) as well as within the 16- to 24-hour time window (moderate quality evidence).4
But that left the question whether the procedure benefits some patients more than others.
To evaluate the efficacy of thrombectomy in different patient groups, researchers conducted a secondary analysis of the larger DEFUSE 3 study. DEFUSE 3 was a randomized, open-label blinded trial that took place at 38 sites in the US between from May 2016 to May 2017. It included 296 individuals with acute ischemic stroke caused by a blood clot in the internal carotid artery or middle cerebral artery.
1. Lansberg MG, Mlynash M, Hamilton S, et al. Association of Thrombectomy With Stroke Outcomes Among Patient Subgroups: Secondary Analyses of the DEFUSE 3 Randomized Clinical Trial. JAMA Neurol. 2019 Jan 28. [Epub ahead of print]
2. Nogueira RG, Jadhav AP, Haussen DC, et al; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11-21.
3. Albers GW, Marks MP, Kemp S, et al; DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378:708-718. doi:10.1056/NEJMoa1713973
4. Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46-e110.