Key Terms: Endovascular therapy (EVT), Mechanical Thrombectomy, Large Vessel Occlusion, CT-Perfusion, Perfusion Mismatch
Hosts: Ryan Muir, Tess Fitzpatrick, Houman Khosravani
Summary:

What is endovascular therapy?

What were the early trials of EVT – what did we learn from them?


MULTI – MERCI

PENUMBRA PIVOTAL

IMS-III



MR. RESCUE
Modified Rankin Scale (MRS) at 90 days).

These trials were summarized in a meta-analysis performed by the HERMES in collaboration in 2016.


MR. CLEAN

ESCAPE

REVASCAT

SWIFT PRIME

EXTEND IA



In the HERMES pooled analysis the number needed to treat with EVT was 2.6 persons to reduce MRS by 1 point.

One trial was done later also favoured EVT, but was not included in the HERMES meta-analysis - the THRACE trial



DAWN
DEFUSE 3
As a result of DAWN and DEFUSE 3, the 2019 AHA/ASA Guidelines now suggest:


Within 0 – 6 hours of symptom onset: Direct aspiration thrombectomy as a first pass or mechanical thrombectomy with a stent retriever should be done if the following criteria are met: (i) prestroke MRS of 0 – 1 (ii) causative occlusion of the internal carotid artery or MCA segment 1 (M1) (iii) age >18 years (4) NIHSS ≥ 6

Within 6 – 24 hours of symptom onset



In selected patients with acute ischemic stroke within 6 – 16 hours of last known normal who have a large vessel occlusion in the anterior circulation and meet other DAWN or DEFUSE 3 eligibility criteria, mechanical thrombectomy is recommended
In selected patients with acute ischemic stroke within 6 – 24 hours of last known normal who have a large vessel occlusion in the anterior circulation and meet other DAWN eligibility criteria, mechanical thrombectomy is reasonable