LB8 - Thrombectomy for Anterior Circulation Stroke Beyond 6 Hours From Time Last Known Well: Final Results of the Aurora (Analysis of Pooled Data From Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well) Collaboration
Author Block: Tudor G Jovin, Cooper Neurological Inst, Camden, NJ; Raul Nogueira, Emory Univ, Atlanta, GA; Maarten Lansberg, STANFORD UNIVERSITY, Palo Alto, CA; Michael D Hill, Univ of Calgary, Alberta, AB, Canada; Shelia Martins, Hosp de Clínicas de Porto Alegre, Porto Alegre, Brazil; J Mocco, The Mount Sinai Hosp, New York, NY; Marc Ribo, Hosp Vall d'Hebron, Barcelona, Spain; Gregory Albers, Stanford Univ, Stanford, CA
Disclosure Block: T.G.Jovin: Honoraria; Modest; Medtronic, Cerenovus, Ownership Interest; Modest; Silk Road, Anaconda, FreeOx Biotech, Research Grant; Modest; Stryker Neurovascular, Stock Shareholder; Modest; VizAi, Blockade Medical, Stock Shareholder; Significant; Corindus. R.Nogueira: Honoraria; Modest; Anaconda, Genentech, Biogen, Prolong Pharmaceuticals , Other; Significant; Stryker Neurovascular , Medtronic , Cerenovus, Phenox , Other Research Support; Modest; Sensome, Other Research Support; Significant; Corindus Vascular Robotics , Speaker/Speaker's Bureau; Modest; IschemaView , Stock Shareholder; Significant; Brainomix , Viz-AI , Corindus Vascular Robotics , Vesalio , Viz-AI, Ceretrieve. M.Lansberg: Other; Modest; Roche, Moleac Singapore Pte. Ltd., Biogen, Nektar Therapeutics, NuvOx Pharma LLC. M.D.Hill: n/a. S.Martins: n/a. J.Mocco: Other; Modest; Perflow, Other; Significant; Synchron, RIST, Viz.ai, Stock Shareholder; Modest; CVaid, Stock Shareholder; Significant; Cerebrotech , Imperative care, Blink TBI, Endostream , Viseon , Serenity, Truvic. M.Ribo: Honoraria; Modest; Cerenovus, Apta Targets, Vesalio, Honoraria; Significant; Medtronic, Stryker, Ownership Interest; Significant; Anaconda Biomed. G.Albers: Other; Significant; iSchemaView, Genentech, Ownership Interest; Significant; iSchemaView.
Background Six randomized trials examining the benefit of thrombectomy in anterior circulation proximal large vessel occlusion stroke have enrolled patients who were randomized beyond 6 hours and up to 24 hours from time last seen well (TLSW). All six trials demonstrated the benefit of thrombectomy. We sought to more precisely define the point estimate of thrombectomy benefit and address remaining questions regarding subgroups through meta-analysis of individual patient data. Methods: The Analysis Of Pooled Data From Randomized Studies Of Thrombectomy More Than 6 Hours After Last Known Well (AURORA) collaboration, pooled patient-level data from the six trials. Primary outcome was reduced disability on the modified Rankin Scale (mRS) at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH) and mortality within 90 days. Heterogeneity of treatment effect by pre-specified subgroups on the primary outcome, functional independence (mRS 0-2) and death at 90 days was tested. Findings: 505 subjects (266 intervention, 239 control) were analyzed. The primary outcome showed benefit of endovascular thrombectomy, adjusted common odds ratio (cOR) 2.54 (CI95 1.83-3.54, p<0.0001). The number needed to treat to reduce disability at least 1 level on mRS was 3. Successful revascularization occurred in 81.0% (216/263) of endovascularly treated patients. No difference between intervention and control arms was found in mortality 16.5% (44/266) versus 19.3% (46/238) or sICH (5.3% (14/266) versus 3.3% (8/239). Subgroup analysis showed no heterogeneity of treatment effect across pre-specified subgroups except for stronger treatment effect in patients randomized in the 12-24 hour time window (cOR 5.86, 95% CI 3.14-10.94) compared to those randomized in the 6-12 hour time window (cOR 1.76, 95% CI 1.18-2.62), p=0.006. Effects favoring thrombectomy were seen in subjects ≥80 years of age (cOR 2.74), subjects with witnessed onset of symptoms beyond 6 hours from randomization (cOR 2.78) and in those with a baseline ASPECTS score of <8 (cOR 2.69). Interpretation This study strengthens the evidence for benefit of endovascular thrombectomy in acute ischemic stroke patients presenting across the entire 6-24 hour time window.