Skip to main content

Indications for Mechanical Thrombectomy

  • Chapter
  • First Online:
Acute Stroke Management in the Era of Thrombectomy

Abstract

The past decade has seen a significant change in the treatment of acute ischemic stroke (AIS). There has been a paradigm shift from a predominantly conservative approach to administration of intravenous thrombolytics and to endovascular thrombectomy. These treatment strategies have been backed by multiple randomized clinical trials. Current evidence suggests that endovascular thrombectomy in the form of stent retriever and/or suction aspiration should be first-line therapy for patients with intracranial large vessel occlusion. The most important aspect for successful outcomes is proper patient selection using clinical and imaging criteria. In this chapter, we follow the evolution of endovascular treatment for acute ischemic stroke and comprehensively discuss the various nuances for proper patient selection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berkhemer OA, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.

    Article  PubMed  CAS  Google Scholar 

  2. Goyal M, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

    Article  CAS  PubMed  Google Scholar 

  3. Saver JL, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.

    Article  CAS  PubMed  Google Scholar 

  4. Campbell BC, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

    Article  CAS  PubMed  Google Scholar 

  5. Jovin TG, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.

    Article  CAS  PubMed  Google Scholar 

  6. National Institute of Neurological, D. and P.A.S.S.G. Stroke rt. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7.

    Article  Google Scholar 

  7. Hacke W, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.

    Article  CAS  PubMed  Google Scholar 

  8. Bhatia R, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254–8.

    Article  CAS  PubMed  Google Scholar 

  9. Broderick JP, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368(10):893–903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Ciccone A, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368(10):904–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kidwell CS, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Demchuk AM, et al. Recanalization and clinical outcome of occlusion sites at baseline CT angiography in the interventional management of stroke III trial. Radiology. 2014;273(1):202–10.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Powers WJ, et al. American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.

    Article  CAS  PubMed  Google Scholar 

  14. Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.

    Article  PubMed  Google Scholar 

  15. Jovin TG, et al. Imaging-based endovascular therapy for acute ischemic stroke due to proximal intracranial anterior circulation occlusion treated beyond 8 hours from time last seen well: retrospective multicenter analysis of 237 consecutive patients. Stroke. 2011;42(8):2206–11.

    Article  PubMed  Google Scholar 

  16. Nogueira RG, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21.

    Article  PubMed  Google Scholar 

  17. Albers GW, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Merwick A, Werring D. Posterior circulation ischaemic stroke. BMJ. 2014;348:g3175.

    Article  PubMed  CAS  Google Scholar 

  19. Gulli G, Markus HS. The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack. J Neurol Neurosurg Psychiatry. 2012;83(2):228–9.

    Article  CAS  PubMed  Google Scholar 

  20. Singer OC, et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol. 2015;77(3):415–24.

    Article  PubMed  Google Scholar 

  21. Powers WJ, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–e110.

    Article  PubMed  Google Scholar 

  22. Mokin M, et al. Clinical and procedural predictors of outcomes from the endovascular treatment of posterior circulation strokes. Stroke. 2016;47(3):782–8.

    Article  CAS  PubMed  Google Scholar 

  23. del Zoppo GJ, et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol. 1992;32(1):78–86.

    Article  PubMed  Google Scholar 

  24. Kim YS, et al. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke. 2005;36(4):869–71.

    Article  PubMed  Google Scholar 

  25. Sivan-Hoffmann R, et al. Stent-retriever thrombectomy for acute anterior ischemic stroke with tandem occlusion: a systematic review and meta-analysis. Eur Radiol. 2017;27(1):247–54.

    Article  PubMed  Google Scholar 

  26. Maurer CJ, Joachimski F, Berlis A. Two in one: endovascular treatment of acute tandem occlusions in the anterior circulation. Clin Neuroradiol. 2015;25(4):397–402.

    Article  CAS  PubMed  Google Scholar 

  27. Maas MB, et al. National institutes of health stroke scale score is poorly predictive of proximal occlusion in acute cerebral ischemia. Stroke. 2009;40(9):2988–93.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Haussen DC, et al. Too good to intervene? Thrombectomy for large vessel occlusion strokes with minimal symptoms: an intention-to-treat analysis. J Neurointerv Surg. 2017;9(10):917–21.

    Article  PubMed  Google Scholar 

  29. Riedel CH, et al. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011;42(6):1775–7.

    Article  PubMed  Google Scholar 

  30. Kaschner MG, et al. Mechanical thrombectomy in MCA-mainstem occlusion in patients with low NIHSS scores. Interv Neuroradiol. 2018;24(4):398–404.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lindvig K, et al. The pattern of cancer in a large cohort of stroke patients. Int J Epidemiol. 1990;19(3):498–504.

    Article  CAS  PubMed  Google Scholar 

  32. von Kummer R, et al. Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology. 1997;205(2):327–33.

    Article  Google Scholar 

  33. Mistry EA, et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Stroke. 2017;48(9):2450–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Joshi, K.C., Chen, M. (2019). Indications for Mechanical Thrombectomy. In: Samaniego, E., Hasan, D. (eds) Acute Stroke Management in the Era of Thrombectomy. Springer, Cham. https://doi.org/10.1007/978-3-030-17535-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17535-1_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17534-4

  • Online ISBN: 978-3-030-17535-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics