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WSC 2022 | Extending the use of mechanical thrombectomy in stroke

Urs Fischer, MD, Basel University Hospital, Basel, Switzerland, and Yvo B. Roos, MD, PhD, Amsterdam University Medical Center, Amsterdam, The Netherlands, discuss ongoing efforts to broaden the applicability of mechanical thrombectomy (MT) for patients following an acute ischemic stroke. Numerous trials looking at the role of MT in patients with a large vessel occlusion have conducted subgroup analyses, all of which support the benefit of MT over best medical management. However, many of these trials employed strict exclusion and inclusion criteria to select patients more suited to thrombectomy. Therefore, there is now interest in the patients that were excluded from these studies who may also benefit from MT. Most recently, the MR CLEAN-LATE trial showed that patients with collateral flow on CT angiography benefit from MT in the 6–24-hour time window, defining a new patient group who can be treated beyond those who meet the CT perfusion criteria set out in the Dutch guidelines (based on DEFUSE 3 and DAWN). Ongoing trials are also looking at patients with distal or medium vessel occlusions to gather data on the value of endovascular treatment in these patients, which account for a substantial proportion of all acute ischemic stroke cases. This interview took place at the World Stroke Congress 2022 in Singapore.

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Prof. Fischer reports the following disclosures:
-research grants from Medtronic (BEYOND SWIFT, SWIFT DIRECT) and from Stryker, Rapid medical, Penumbra and Phenox (DISTAL).
-consultancies for Medtronic, Stryker, and CSL Behring (fees paid to institution).
-participation in an advisory board for Alexion/Portola and Boehringer Ingelheim (fees paid to institution).