
pmid: 31009772
The indications for mechanical thrombectomy (MT) have expanded since the American Heart Association/American Stroke Association reported its first guidelines for MT in 2013. Multiple subsequent randomized clinical trials of MT have proved its efficacy, including the DAWN (DWI [diffusion weighted imaging] or CTP [computed tomography perfusion] Assessment with Clinical Mismatch in the Triage of Wake-up and Late Presenting Strokes Undergoing Neurointervention with Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke-3) trials. The current guidelines from the American Heart Association/American Stroke Association provide class I support for the use of MT for the following indications: 1) internal carotid artery (ICA)/M1 middle cerebral artery (MCA) occlusion, symptom onset <6 hours, National Institutes of Health Stroke Scale score of ≥6, Alberta Stroke Program Early Computed Tomography Score of ≥6; and 2) large vessel occlusions in the anterior circulation, symptom onset 6-16 hours, and meeting the DAWN or DEFUSE-3 eligibility criteria. Class IIa evidence is also available for the use of MT for large vessel occlusions in the anterior circulation, symptom onset 16-24 hours, and meeting other DAWN eligibility criteria. In clinical practice, these class I and IIa indications for MT have been well followed. However, many other potential indications are available, including 1) M2 or M3 MCA occlusion, symptom onset <6 hours; 2) Alberta Stroke Program Early Computed Tomography Score <6, ICA or M1 MCA occlusion, symptom onset <6 hours; 3) National Institutes of Health Stroke Scale score <6, ICA or M1 occlusion, symptom onset <6 hours; 4) tandem occlusions; and 5) posterior circulation occlusion <6 hours. The present review analyzed the available data to provide support for further prospective clinical trials regarding these potential indications.
Adult, Clinical Trials as Topic, Adolescent, Mechanical Thrombolysis, Infarction, Middle Cerebral Artery, Middle Aged, Mechanical, Indication, Stroke, Young Adult, Treatment Outcome, Neurology, Medicine and Health Sciences, Humans, Carotid Stenosis, Carotid Artery, Internal, Thrombectomy, Aged
Adult, Clinical Trials as Topic, Adolescent, Mechanical Thrombolysis, Infarction, Middle Cerebral Artery, Middle Aged, Mechanical, Indication, Stroke, Young Adult, Treatment Outcome, Neurology, Medicine and Health Sciences, Humans, Carotid Stenosis, Carotid Artery, Internal, Thrombectomy, Aged
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