Mechanical thrombectomy for acute large vessel occlusion stroke beyond 24 h

Pandhi, Abhi; Chandra, Rahul; Abdulrazzak, Mohammad A; Alrohimi, Anas; Mahapatra, Ashutosh; Bain, Mark; Moore, Nina Z.; Hussain, MS; Bullen, Jennifer; Tóth, Gábor

doi:10.1016/j.jns.2023.120594

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…There have been isolated case reports of BAO, which have been treated with mechanical thrombectomy after a long duration beyond even 24 hours. Pandhi et al 18 reported their experience treating 10 patients who underwent thrombectomy beyond 24 hours from symptom onset. Successful recanalization (Thrombolysis in Cerebral Infarction 2b-3) was achieved in five patients (50%), which indicates that thrombectomy is feasible and technically successful in this population.…”

Section: Thrombectomy For Posterior Circulation Large Vessel Occlusio...mentioning

confidence: 99%

Focused update to guidelines for endovascular therapy for emergent large vessel occlusion: basilar artery occlusion patients

Heit,

Chaudhary,

Mascitelli

et al. 2024

J NeuroIntervent Surg

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BackgroundEndovascular therapy (EVT) dramatically improves clinical outcomes for patients with anterior circulation emergent large vessel occlusion (ELVO) strokes. With recent publication of two randomized controlled trials in favor of EVT for basilar artery occlusions, the Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee provides this focused update for the existing SNIS guideline, ‘Current endovascular strategies for posterior circulation large vessel occlusion stroke.’MethodsA structured literature review and analysis of studies related to posterior circulation large vessel occlusion (basilar or vertebral artery) strokes treated by EVT was performed. Based on the strength and quality of the evidence, recommendations were made by consensus of the writing committee, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors.ResultsBased on the results of the most recent randomized, controlled trials on EVT for basilar or vertebral artery occlusion, the expert panel agreed on the following recommendations. For patients presenting with an acute ischemic stroke due to an acute basilar or vertebral artery occlusion confirmed on CT angiography, National Institutes of Health Stroke Scale (NIHSS) score of ≥6, posterior circulation Alberta Stroke Program Early CT Score (PC-ASPECTS) ≥6, and age 18–89 years: (1) thrombectomy is indicated within 12 hours since last known well (class I, level B-R); (2) thrombectomy is reasonable within 12–24 hours from the last known well (class IIa, level B-R); (3) thrombectomy may be considered on a case by case basis for patients presenting beyond 24 hours since last known well (class IIb, level C-EO). In addition, thrombectomy may be considered on a case by case basis for patients aged <18 years or >89 years on a case by case basis (class IIb, level C-EO).ConclusionsThe indications for EVT of ELVO strokes continue to expand and now include patients with basilar artery occlusion. Further prospective, randomized controlled trials are warranted to elucidate the efficacy and safety of EVT in populations not included in this set of recommendations, and to confirm long term outcomes.

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Section: Thrombectomy For Posterior Circulation Large Vessel Occlusio...mentioning

confidence: 99%