Thrombectomy Benefits Extended to Large Ischemic Stroke

Three trials have shown remarkable benefits of thrombectomy in patients with large ischemic strokes in countries with different medical systems. The benefits of thrombectomy were consistent across age, degree of neurologic deficit, imaging characteristics, time of treatment, and geographic location. Thrombectomy resulted in significantly better functional outcomes than medical care in a Japanese trial of 202 patients, without significantly higher incidence of symptomatic intracranial hemorrhage but higher incidence of any intracranial hemorrhage. In the trial of 352 patients from the US, Canada, Europe, Australia, and New Zealand, the score on the modified Rankin scale to assess disability favored thrombectomy, with similar mortality and symptomatic intracranial hemorrhage but more frequent and worse neurologic worsening. Another Chinese trial of 456 patients showed good outcomes in 47.0% of the patients in the endovascular-thrombectomy group, as compared with 33.3% of the patients in the medical-management group, although the incidences of symptomatic intracranial hemorrhage, any intracranial hemorrhage, and hemicraniectomy were higher with thrombectomy than with medical management. So, it is reasonable to suggest that endovascular thrombectomy be offered to patients with large strokes if they arrive in a timely fashion at a center that can perform the procedure. The benefits of thrombectomy in patients with small-to-moderate acute ischemic strokes has been known. Source: https://www.nejm.org/