[Acute endovascular thrombectomy for cerebral infarction]

Area of Science:

• Neurology
• Interventional Cardiology
• Medical Imaging

Context:

• Large vessel occlusion ischemic stroke requires timely intervention.
• Current Dutch guidelines for endovascular thrombectomy (EVT) in later time windows (>6 hours) have specific infarct core and penumbra size criteria.
• Previous treatment criteria may have excluded patients who could benefit from EVT.

Purpose:

• To evaluate the effectiveness of EVT in patients with large vessel occlusion ischemic stroke.
• To reassess and potentially modify treatment criteria for EVT, particularly in later time windows.
• To explore alternative patient selection methods beyond infarct core and penumbra size.

Summary:

• Endovascular thrombectomy is a leading treatment for ischemic stroke caused by large vessel occlusion.
• The MR CLEAN LATE trial demonstrated the efficacy of EVT in a later time window (>6 hours).
• Patient selection for late-window EVT can effectively utilize collateral circulation assessment, potentially replacing ASPECT score and CT perfusion criteria.

Impact:

• This research refines treatment guidelines for ischemic stroke, expanding the potential patient pool for EVT.
• Improved patient selection can lead to better outcomes and reduced disability.
• The findings support the use of collateral circulation as a key factor in deciding on late-window EVT.