Thrombectomy for acute ischaemic stroke without advanced imaging

Endovascular thrombectomy is a complex and delicate procedure, which needs to be carried out without delay in patients with acute ischaemic stroke. The procedure itself might lead to extracranial complications and intracerebral haemorrhage. Trials have shown that taking these risks is reasonable and worthwhile in patients who potentially benefit from re-vascularisation. 1 Goyal M Menon BK van Zwam WH et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387: 1723-1731 Summary Full Text Full Text PDF PubMed Google Scholar The outcome depends on the severity of symptoms and size of the ischaemic area. The earlier the treatment is carried out, the greater the benefit. A 1-h delay reduces the beneficial effect of re-vascularisation on good functional outcome by about 6–8 percentage points. 2 Saver JL Goyal M van der Lugt A et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016; 316: 1279-1288 Crossref PubMed Scopus (1383) Google Scholar Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trialEndovascular thrombectomy was associated with improved functional outcome and lower mortality in patients with acute ischaemic stroke from large vessel occlusion with established large infarct in a setting using non-contrast CT as the predominant imaging modality for patient selection. Full-Text PDF