Thrombectomy in acute ischemic stroke in the extended time window: Real-life experience in a high-volume center

Article Medicine, General & Internal

Endovascular Therapy for Acute Stroke with a Large Ischemic Region

S. Yoshimura et al.

Summary: In a trial conducted in Japan, patients with large cerebral infarctions had better functional outcomes with endovascular therapy than with medical care alone but had more intracranial hemorrhages.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

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Article Neuroimaging

POSITIVE: Perfusion imaging selection of ischemic stroke patients for endovascular therapy

J. Mocco et al.

Summary: The POSITIVE trial aimed to evaluate functional outcomes in ELVO patients within 0-12 hours using perfusion imaging for thrombectomy. Despite early termination, results showed statistically significant superior outcomes for thrombectomy over medical management, supporting the practice of delayed thrombectomy for appropriately selected patients.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2022)

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Article Clinical Neurology

Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion

Thanh N. Nguyen et al.

Summary: In patients undergoing mechanical thrombectomy for proximal anterior circulation stroke in the extended time window, there were no significant differences in clinical outcomes between those selected with noncontrast CT compared to those selected with CTP or MRI. This suggests that noncontrast CT alone may be a simpler alternative for selecting patients with late-presenting large-vessel occlusion for mechanical thrombectomy.

JAMA NEUROLOGY (2022)

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Article Clinical Neurology

CT perfusion core and ASPECT score prediction of outcomes in DEFUSE 3

May Kim-Tenser et al.

Summary: The study aimed to investigate the role of ASPECTS and core infarction volume in predicting clinical outcomes in late time windows for thrombectomy patients. The results showed that higher ASPECTS scores were associated with functional independence at 90 days, and core infarction volume did not impact the thrombectomy treatment effect. This suggests that patients with target mismatch profile on perfusion imaging should undergo thrombectomy regardless of ASPECTS or core infarction volume.

INTERNATIONAL JOURNAL OF STROKE (2021)

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Article Neuroimaging

What predicts poor outcome after successful thrombectomy in late time windows?

Jeremy J. Heit et al.

Summary: Older age, female gender, higher NIHSS score, poor cerebral perfusion collaterals, larger core infarctions, and delayed time from imaging to arterial puncture were associated with poor outcomes following successful thrombectomy in acute ischemic stroke treatment. Mild and severe reperfusion hemorrhage also predicted poor outcomes in late time windows.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2021)

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Article Neuroimaging

Effect of age and baseline ASPECTS on outcomes in large-vessel occlusion stroke: results from the HERMES collaboration

Johanna Maria Ospel et al.

Summary: The study found no multiplicative interaction of age and ASPECTS on clinical outcomes in patients with acute ischemic stroke. For patients aged 75 and above with ASPECTS 0-5, poor outcomes were observed regardless of treatment.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2021)

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Article Neuroimaging

Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study

Adam de Havenon et al.

Summary: The study compared outcomes of M1 and M2 occlusions in the ARISE II trial, finding that M2 occlusions achieved a good outcome rate of 70.2% at 90 days, which was not significantly different from M1 occlusions. Reperfusion rates and adverse events were also similar between the two groups.

JOURNAL OF NEUROINTERVENTIONAL SURGERY (2021)

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Article Medicine, General & Internal