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Indications for Mechanical Thrombectomy-Too Wide or Too Narrow?
Zeguang Ren1, Maxim Mokin2, Clayton T Bauer2
1Department of Neurosurgery, University of South Florida, Tampa, Florida, USA; Center for Cerebrovascular Diseases, Taihe Hospital, Shiyan, Hubei, China.
World Neurosurgery
|April 23, 2019
Summary
Mechanical thrombectomy (MT) is effective for acute ischemic stroke, with expanded indications beyond initial guidelines. This review supports further trials for potential new MT uses in stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Cardiovascular Medicine
Background:
- Mechanical thrombectomy (MT) guidelines for acute ischemic stroke have evolved since 2013.
- Randomized trials like DAWN and DEFUSE-3 have established MT efficacy for specific indications.
- Current guidelines support MT for anterior circulation large vessel occlusions within 16 hours, with class IIa evidence up to 24 hours.
Purpose of the Study:
- To review current indications for mechanical thrombectomy in acute ischemic stroke.
- To analyze data supporting potential expanded indications for MT.
- To advocate for prospective clinical trials on these new indications.
Main Methods:
- Review of existing literature and clinical trial data on mechanical thrombectomy.
- Analysis of established and potential MT indications based on occlusion type, time window, and patient severity scores.
- Synthesis of evidence to support future research directions.
Main Results:
- Current guidelines support MT for internal carotid artery/M1 middle cerebral artery occlusions (<6 hours) and anterior circulation large vessel occlusions (6-24 hours) meeting specific criteria.
- Several potential indications warrant further investigation, including M2/M3 MCA occlusions, lower ASPECTS scores, lower NIHSS scores, tandem occlusions, and posterior circulation occlusions.
Conclusions:
- Established indications for MT in acute ischemic stroke are widely adopted.
- Further prospective trials are needed to evaluate the efficacy of MT for several emerging indications.
- Expanding MT indications could benefit a broader range of stroke patients.
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