7 Outcomes of medically-treated patients with M2-segment middle cerebral artery occlusion. Results from the prospective multicentral international cohort study INTERRSeCT

Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

“…DAWN [2], DEFUSE3 [3], and late window patients in ESCAPE [4] trials show the benefit of thrombectomy up to 24 h. Data from HERMES collaboration show benefit with thrombectomy even in patients with large ischemic core [(irrespective of whether evaluated on the Alberta Stroke Program Early CT Score (ASPECTS) or CT perfusion (CTP)] and moderate to good collaterals [5,6]. While there remains no published data from randomized trials on more distal occlusions, evidence from quality registries on thrombectomy in sizable middle cerebral artery M2-segment occlusions suggests that thrombectomy is safe and effective [7][8][9][10][11]. The further incentive can be found in the dismal natural history of acute proximal occlusion and the low complication rate of thrombectomy, in trials and registries [1].…”