Core Concepts
Thrombectomy in low-income populations can be beneficial without advanced imaging but may not benefit older patients due to frailty.
Abstract
The RESILIENT-Extend trial conducted in Brazil explored the benefits of thrombectomy in the late time window for stroke patients. Key highlights include:
- Simplified selection criteria based on non-contrast CT
- Potential alteration of current guidelines
- Lack of benefit in older patients due to frailty
- Bidirectional results on modified Rankin Scale
- Increased chances of good outcomes with thrombectomy
- Concerns about increased risk for severe disability or death
- Importance of considering specific populations and factors like socioeconomic status and frailty
- Potential ceiling effect for benefit of thrombectomy in frail patients
- Absolute benefit of thrombectomy but also a signal of harm
- Physiological differences in patients compared to other trials
- Positive impact on extending access to thrombectomy in resource-limited settings
Stats
"The trial enrolled 245 patients with a large vessel occlusion stroke within 8-24 hours of last known well."
"The median baseline NIHSS score was 16, and the median ASPECTS score was 7-8."
"The number of patients achieving a good outcome (mRS, 0-2) was significantly increased with thrombectomy (25% vs 14%, adjusted odds ratio, 2.56; P = .012)."
Quotes
"The RESILIENT-Extend trial is the first major study of thrombectomy in the late time window (8-24 h) conducted outside first world countries and shows the procedure also has benefit in a lower socioeconomic status population without the need for costly imaging equipment." - Raul G. Nogueira, MD
"Both the RESILIENT trials have shown that thrombectomy does not appear to be suitable for older patients (over 68-70) years of age in the public health service in Brazil." - Raul G. Nogueira, MD