Endovascular Thrombectomy Better Than Medical Therapy for Stroke — But Only When Performed Early

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

For patients with ischemic stroke, endovascular thrombectomy plus medical therapy is superior to medical therapy alone — but only when thrombectomy is performed soon after symptom onset — according to a meta-analysis in JAMA.

The analysis included data from five phase 3 trials in which nearly 1300 patients with ischemic stroke due to intracranial large vessel occlusion were randomized to endovascular thrombectomy (with stent retrievers or other second-generation devices) plus medical therapy or to medical therapy alone.

Patients undergoing endovascular thrombectomy had less disability at 3 months than those who received medical therapy alone (mean disability score: 2.9 vs. 3.6 on a 6-point scale). However, the efficacy of thrombectomy declined with each hour from symptom onset to arterial puncture, and with each hour from symptom onset to reperfusion achievement. Overall, thrombectomy outperformed medical therapy alone only when treatment began within 7.3 hours of symptom onset.

Editorialists write, "These data have important implications for how stroke services should be organized, including the time at which thrombectomy should not be attempted."