Thrombectomy in Patients with Large Ischemic Strokes – Guidelines Knowledge Check

Andrea Eberly, MD, MS, FAAEMBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Pediatric Emergency Medicine, Pediatric Medicine, Physician Assistant, Urgent Care

Thrombectomy in Patients with Large Ischemic Strokes - Study Findings

Thrombectomy in Patients with Large Ischemic Strokes - Guideline Knowledge Check

Andrea Eberly, MD, MS, FAAEM examines newly released data addressing the use of thrombectomy in patients with large ischemic stroke.

In 2019, the American Heart Association (AHA) published stroke guidelines that, mostly due to a lack of data, did not recommend thrombectomy in patients with very large ischemic strokes.

This data gap was recently (April 2022) addressed by a Japanese study.

What did the study find with regards to thrombectomy in patients with very large ischemic strokes?

Try this case and test your knowledge of the latest information regarding thrombectomy in patients with very large ischemic strokes.

A 73-year-old, previously healthy man (modified Rankin score of 0) presents to a stroke center with a 2-hour history of a large left-sided ischemic stroke in his anterior circulation and an NIHSS score of 16.

Emergent computed tomography (CT) shows no hemorrhage, an angiogram shows an occlusion of the proximal section of the middle cerebral artery (MCA).

His Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is 4.

Question:

According to a recent Japanese study, how does the addition of thrombectomy to routine medical care (with thrombolysis when eligible) affect recovery in previously high-functioning patients with a large ischemic stroke?

Answer Options:

Adding endovascular therapy results in marginally better outcomes, but this difference does not translate into a higher degree of independence at 90 days.

Patients with large cerebral infarctions experience similar improvements in their NIHSS score at 48 hours, whether they receive medical therapy alone (incl. thrombolysis when eligible) or medical therapy plus endovascular treatment.

Adding endovascular therapy results in significantly more symptomatic intracranial hemorrhages.

Adding endovascular therapy results in significantly better functional recovery without a statistically significant increase in symptomatic hemorrhages.

See the Answer:

Dr. Andrea Eberly is one of the seasoned medical experts that contribute to Med-Challenger Medical Education products for medical board certification exam preparation, maintenance of medical certification, and continuing medical education requirements. 

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