Thrombectomy for proximal intracranial occlusion beyond 24 hours after time last seen normal: A narrative review

Neda Jafri, Savanna Dasgupta, James E. Siegler
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Abstract

Endovascular thrombectomy (EVT) revolutionized the treatment for acute ischemic stroke due to large vessel occlusion (LVO). Current guidelines published by multiple academic societies recommend EVT for eligible patients who present within 24 hours of the time last seen well. However, more recent data suggests that extending this window past 24 hours produces more favorable outcomes in specific patients presenting with anterior circulation LVO. More specifically, recent observational data indicates a higher probability of functional independence, functional improvement, and long-term survival with EVT when compared to best medical management. Based on the available data, there is unclear equipoise in randomizing all patients with acute ischemic stroke due to LVO to EVT or medical management. However, for those patients with large established infarction, distal occlusions, or well beyond the 24-hour window, randomized clinical trials are called upon to determine whether there is benefit of EVT in these patient groups. In this narrative review, we will summarize the most recent data on EVT in the ultra extended window (>24 hours after time last seen normal) and discuss further considerations of this treatment.
近端颅内闭塞超过24小时后,最后一次看到正常的血栓切除术:叙述性回顾
血管内血栓切除术(EVT)彻底改变了大血管闭塞(LVO)引起的急性缺血性脑卒中的治疗。目前由多个学术团体发布的指南建议,在最后一次就诊24小时内就诊的符合条件的患者应接受EVT治疗。然而,最近的数据表明,将这一窗口延长至24小时后,对于出现前循环LVO的特定患者会产生更有利的结果。更具体地说,最近的观察数据表明,与最佳医疗管理相比,EVT患者功能独立、功能改善和长期生存的可能性更高。根据现有的数据,将所有由左心室vo引起的急性缺血性卒中患者随机分配到EVT或医疗管理中存在不明确的均衡性。然而,对于那些大面积梗死、远端闭塞或远超过24小时窗口的患者,需要随机临床试验来确定EVT在这些患者组中是否有益处。在这篇叙述性综述中,我们将总结超延长窗期(离最后一次正常时间24小时后)EVT的最新数据,并讨论这种治疗的进一步考虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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