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Beyond 6 Hours: With MR Selection, Improved Outcomes after Successful Late Thrombectomy in Anterior Circulation Large Vessel Occlusion Stroke
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  • Brian Cristiano,
  • Matthew Pond,
  • Somnath Basu,
  • Udochukwu Oyoyo,
  • J. Paul Jacobson
Brian Cristiano
Loma Linda Univeristy Hospital

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Matthew Pond
Loma Linda Univerisity Hospital
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Somnath Basu
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Udochukwu Oyoyo
Loma Linda University
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J. Paul Jacobson
Loma Linda University Hospital
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Abstract Purpose The benefit of thrombectomy among patients with anterior circulation large vessel occlusion (LVO) stroke is unclear beyond 6 hours. Here we sought to ascertain whether or not successful thrombectomy is beneficial when performed in MR-selected patients more than 6 hours after stroke onset. Methods A cohort of 30 LVO patients who underwent thrombectomy after MR selection between 11/1/2012 until 5/15/2015 was studied. Patients were selected for thrombectomy based on small diffusion-restricted core volume at presentation. Patients with decision to treat later than 6 hours from symptom onset and who achieved TICI≥2B recanalization (n=21) were compared against patients with failed thrombectomy (TICI<2B) at any time (n=9). Outcomes measures were final infarct volume and disposition from hospital. Results The median time from symptom onset to access for the successful late thrombectomy group was 10.6 h (IQR 7.8 – 14.4). Compared with the failed intervention group, patients with successful late thrombectomy had smaller median final infarct volume (20 mL v. 53 mL, p = 0.045), less median infarct growth (+4 mL v. +43 mL, p = 0.036), and were more likely to be discharged home or to rehab (66.7% v. 22.2%, OR 7.14 [95% CI:  1.26 – 34.5]). Conclusion Late MR-selected LVO patients had smaller final core volumes and superior in-hospital clinical outcomes after successful thrombectomy compared with similar patients who had failed or incomplete thrombectomy. Favorable outcomes were achieved well beyond 6 hours.