Persistent challenges in endovascular treatment decision-making for acute ischaemic stroke

TY - JOUR

T1 - Persistent challenges in endovascular treatment decision-making for acute ischaemic stroke

AU - Fiehler, Jens

AU - Nawka, Marie Teresa

AU - Meyer, Lukas

N1 - Copyright © 2021 Wolters Kluwer Health, Inc. All rights resereved.

PY - 2022/2/1

Y1 - 2022/2/1

N2 - PURPOSE OF REVIEW: Although endovascular treatment (EVT) is the gold standard for treating acute stroke patients with large vessel occlusion (LVO), multiple challenges in decision-making for specific conditions persist. Recent evidence on a selection of patient subgroups will be discussed in this narrative review.RECENT FINDINGS: Two randomized controlled trials (RCTs) have been published in EVT of basilar artery occlusion (BAO). Large single arm studies showed promising results in Patients with low Alberta stroke program early CT score (ASPECTS) and more distal vessel occlusions. Recent data confirm patients with low National Institutes of Health Stroke Scale (NIHSS) despite LVO to represent a heterogeneous and challenging patient group.SUMMARY: The current evidence does not justify withholding EVT from BAO patients as none of the RCTs showed any signal of superiority of BMT alone vs. EVT. Patients with low ASPECTS, more distal vessel occlusions and patients with low NIHSS scores should be included into RCTs if possible. Without participation in a RCT, patients should be selected for EVT based on age, severity and type of neurological impairment, time since symptom onset, location of the ischaemic lesion and perhaps also results of advanced imaging.

AB - PURPOSE OF REVIEW: Although endovascular treatment (EVT) is the gold standard for treating acute stroke patients with large vessel occlusion (LVO), multiple challenges in decision-making for specific conditions persist. Recent evidence on a selection of patient subgroups will be discussed in this narrative review.RECENT FINDINGS: Two randomized controlled trials (RCTs) have been published in EVT of basilar artery occlusion (BAO). Large single arm studies showed promising results in Patients with low Alberta stroke program early CT score (ASPECTS) and more distal vessel occlusions. Recent data confirm patients with low National Institutes of Health Stroke Scale (NIHSS) despite LVO to represent a heterogeneous and challenging patient group.SUMMARY: The current evidence does not justify withholding EVT from BAO patients as none of the RCTs showed any signal of superiority of BMT alone vs. EVT. Patients with low ASPECTS, more distal vessel occlusions and patients with low NIHSS scores should be included into RCTs if possible. Without participation in a RCT, patients should be selected for EVT based on age, severity and type of neurological impairment, time since symptom onset, location of the ischaemic lesion and perhaps also results of advanced imaging.

KW - Brain Ischemia/drug therapy

KW - Endovascular Procedures

KW - Humans

KW - Ischemic Stroke

KW - Stroke/therapy

KW - Thrombectomy

KW - Thrombolytic Therapy

KW - Treatment Outcome

U2 - 10.1097/WCO.0000000000001006

DO - 10.1097/WCO.0000000000001006

M3 - SCORING: Review article

C2 - 34812746

VL - 35

SP - 18

EP - 23

JO - CURR OPIN NEUROL

JF - CURR OPIN NEUROL

SN - 1350-7540

IS - 1

ER -