Patients with cerebrovascular accidents caused by large vessel occlusions (LVOs) usually have severe physiological deficits. Despite causing roughly one-third of all ischemic cases, they are responsible for more death rates. Research has shown that patients with these vessel occlusions can benefit from thrombectomy within 6-8 hours of a stroke. More recently, research has indicated that this treatment can be successful in some LVO patients up to 24 hours following vascular infarct. The rise of the treatment time window opens new avenues for treating LVO patients.
In certain hospitals, the challenge is getting patients who will gain from thrombectomy despite late arrivals or delays due to transfer to intervention-capable centers.
A current study analyzed a cohort of patients with consistent MRIs over two days to identify biomarkers likely to have a better prognosis with thrombectomy despite significant delays up to 24 hours.
Better prognosis for stroke with the new study
The current research aimed to find patient biomarkers that, when measured at the first hospitalization, predicted that the stroke infarct core would be no larger than 50ml 24 hours after stroke onset. The time and infarct core size are in line with research findings. Most stroke patients in developed regions like North America, Europe, and Japan are within a 24-hour drive of a thrombectomy-capable facility.
The ischemic core target volume of 50ml is from using data from prospective thrombectomy clinical data. These trials used core volumes of less than 50ml as inclusion criteria. Data from other research collaborations revealed that patients with final infarcts of 50ml after treatment had an 80% functional independence at three months, even when presented with severe symptoms.
Patients with potentially severe strokes caused by LVO but have favorable physiology have small infarct cores that grow slowly and are likely to be excellent candidates for thrombectomy despite significant time delays.
The researchers discovered that an infarct core growth rate of 4.1 ml/hr or an initial infarct core volume of 19.9 ml is the best biomarkers of such improved physiology when using a target ischemic core volume of 50 ml at 24 hours. The ability to reliably identify LVO slow progressors could greatly expand the use of thrombectomy. Researchers can also apply the lessons learned from these recent trials. The application of this research opens possibilities for stroke treatment.
Stroke has a high death ratio and is a leading cause of disability-adjusted years globally. The use of thrombectomy can improve the prognosis of patients. The current research helps identify patients that can gain even up to one day following a stroke. This finding help with recovery and independence for patients.
Stroke treatment is time bound and critical. However, there is usually a delay in getting fast treatment. With the current study showing the possibility of treatment intervention up to 24 hours after a stroke, more people can benefit and get better recovery rates.