I lost both of my parents to strokes. So whenever, an article pops up I pay particular attention. I also remember the great promise of tPA and other modalities for the treatment of stroke. Most recently, thrombectomy by our interventional colleagues has come to fruition and even availability through rapid transport. But with each of the therapeutic options comes questions. The most common question involves time frame for each procedure. With peripheral tPA the question is 3 hours or 4.5 hours. With thrombectomy the question is also at what time frame does the patient lose benefit from the procedure. The article in the September 27, 2016 issue of JAMA attempted to answer the question.
Question What is the relation between time to treatment and outcome from endovascular mechanical thrombectomy for acute ischemic stroke?Findings In this meta-analysis of pooled individual patient data from 1287 adults in 5 randomized trials, compared with medical therapy alone, thrombectomy up to 7.3 hours after symptom onset was associated with improved outcomes. Rates of functional independence after thrombectomy were 64% with reperfusion at 3 hours vs 46% with reperfusion at 8 hours.Meaning In acute ischemic stroke due to large-vessel occlusion, endovascular mechanical thrombectomy should be initiated as soon as possible within the first 7 hours after symptom onset.
My take away is that you definitely have to get the person to an interventional radiology facility with 7 hours or you should pursue standard supportive protocols.