Endovascular treatment vs. best medical management for late window ischemic stroke patients with large vessel occlusion.

BackgroundTo compare the benefit of endovascular treatment(EVT) in acute ischemic stroke(AIS) patients with large vessel occlusion(LVO) presenting > 6 h from last known well outside a clinical trial setting to best medical management and to EVT in a randomized trial setting.MethodsData from a retrospective multicenter cohort study (ESCAPE-LATE) of AIS-LVO patients treated with EVT beyond 6 hours from last known well at former ESCAPE trial sites were pooled with historical data from ESCAPE trial late time window patients. Unadjusted and adjusted 90-day modified Rankin Scale (mRS) score was compared between ESCAPE-LATE patients, ESCAPE late time window EVT arm and control arm patients.ResultsA total of 249 patients were included in the analysis: 200 ESCAPE-LATE patients (for 141 of whom 90-day clinical outcomes were available) and 49 ESCAPE patients, for all of whom clinical outcome data were available (control arm: 20 and EVT arm: 29). Good clinical outcome (mRS 0-2 at 90 days) was nominally, albeit not significantly, lower in patients not treated with EVT (5/19[26.3%]) as compared to ESCAPE EVT arm patients (13/29[44.8%] and ESCAPE-LATE patients (66/141[46.8%]). After adjustment, a graded mRS pattern was seen, whereby patients treated with EVT did better as compared to non-treated patients, and those who underwent EVT in the ESCAPE trial had better mRS as compared to those included in ESCAPE-LATE who underwent EVT in clinical routine.ConclusionPatients presenting beyond 6 hours from last known well who are treated with EVT in a real-world setting show comparable benefit to patients treated in a clinical trial setting.