Successful endovascular thrombectomy 90h after stroke onset

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Established treatment windows for endovascular thrombectomy (EVT) exist, based on trials like ECASS III and HERMES.
• Recent studies (e.g., DAWN trial) have expanded these windows to 24 hours for select patients.
• Patients presenting late with large ischemic areas but minimal established infarction pose a clinical dilemma for EVT.

Observation:

• A case of near-complete left M1 middle cerebral artery occlusion is presented.
• Endovascular thrombectomy (EVT) was performed 90 hours and 41 minutes after stroke onset.
• The patient achieved an excellent clinical outcome following the delayed intervention.

Findings:

• Successful reperfusion was achieved despite the extended time from stroke onset to EVT.
• The patient's excellent outcome suggests that time alone may not be the sole determinant for EVT eligibility.
• This case challenges the strict adherence to current time-based guidelines for EVT.

Implications:

• Current EVT treatment window guidelines, such as those from the HERMES collaboration, may not fully account for individual patient factors.
• Delayed EVT in carefully selected patients, even significantly beyond established windows, can lead to positive clinical outcomes.
• Further research is warranted to refine patient selection criteria for extended EVT treatment windows.