Endovascular therapy is transforming the management of strokes caused by large vessel occlusion (LVO), a leading cause of disability and death worldwide. A recent review published in The Lancet provides an update on the advancements and ongoing knowledge gaps in this critical intervention. The review, authored by researchers from Boston University Chobanian & Avedisian School of Medicine and international collaborators, highlights the expanded treatment window and evolving patient selection criteria for endovascular therapy.
Expanded Treatment Window
Recent clinical trials have extended the treatment window for endovascular therapy from 6 to 24 hours after symptom onset. This expansion potentially benefits more patients, offering a longer period in which intervention can be effective. The therapy has also proven effective for patients with large ischemic core infarcts and basilar artery occlusions, further broadening its application.
Simplified Patient Selection
The review also notes the simplification of patient selection criteria for endovascular therapy. According to the researchers, most patients with a National Institutes of Health Stroke Scale (NIHSS) score higher than 5 and anterior circulation occlusion, or those with an NIHSS score of 10 or higher and basilar occlusions, are good candidates for the therapy within the 24-hour window. These criteria help clinicians make quicker decisions about which patients are most likely to benefit from the intervention.
Ongoing Research Needs
Despite these advancements, the authors acknowledge that more studies are needed to definitively understand which patients with large ischemic infarcts are more likely to benefit from endovascular therapy. Further research is also necessary to determine the role of endovascular therapy for patients with low stroke severity scores or medium to distal vessel occlusions.
"Our paper is a contemporary update of the role of endovascular therapy (clot retrieval, rescue stenting) in the treatment of patients with acute ischemic stroke as well as patient selection criteria," said Thanh Nguyen, MD, professor of neurology, neurosurgery and radiology at Boston University Chobanian & Avedisian School of Medicine.
