Is thrombectomy indicated in all ischemic stroke with large vessel occlusion?

Area of Science:

• Neurology
• Interventional Cardiology
• Vascular Surgery

Background:

• Acute ischemic stroke due to large vessel occlusion (LVO) is a time-sensitive medical emergency.
• Endovascular thrombectomy (EVT) has emerged as a primary treatment for LVO, significantly improving patient outcomes.
• Selected patient populations, including those with large core strokes or extended time windows, are increasingly considered for EVT.

Approach:

• This topical review synthesizes current randomized and nonrandomized evidence on EVT efficacy and safety.
• The review examines EVT application in diverse patient subgroups beyond initial indications.
• It highlights the need for further randomized controlled trials to solidify EVT's role in specific populations.

Key Points:

• EVT is established as first-line therapy for LVO with limited ischemic changes.
• Recent trials support EVT in large core strokes and basilar occlusions up to 24 hours.
• Nonrandomized data suggest potential EVT benefits in mild strokes, distal occlusions, and beyond 24 hours.

Conclusions:

• EVT is a cornerstone treatment for acute ischemic stroke from LVO.
• Evidence supports expanding EVT to select patients with large core strokes and extended time windows.
• Individualized risk-benefit assessment is crucial for EVT decisions in populations lacking definitive randomized evidence.