mechanical thrombectomy in Stroke patients

Q: For mechanical thrombectomy in Stroke patients, which of the following statement is valid?

A) Within 6 hours of stroke symptom onset, whether or not the patient received intravenous tPA
B) Within 6 hours of stroke symptom onset, only if intravenous tPA is not given
C) Within 3 hours of stroke symptom onset, whether or not the patient received intravenous tPA
D) Within 3 hours of stroke symptom onset, only if intravenous tPA is not given
E) On call neurologist can decide each patient on a case to case basis.


Answer: A

It is hard to describe here full criteria for mechanical thrombectomy in Stroke patients but ideally as a rule of thumb following few conditions should be met.

1. A clinical diagnosis of acute stroke
2. Femoral puncture can be accessed/performed
3. A deficit on the NIH Stroke Scale of ≥6 points
4. An Alberta Stroke Program Early CT Score (ASPECTS) score ≥6
5. No evidence of intracranial hemorrhage
6. Radiologically documented Intracranial arterial occlusion of the distal intracranial internal carotid artery (ICA), or the middle (M1/M2) or anterior (A1/A2) cerebral artery
7. Age ≥18 years

Actually, mechanical thrombectomy can be extended up to 24 hours in few situations. 

Please refer to references for detailed guidelines.


References/further reading:

1. Powers WJ, Rabinstein AA, Ackerson T, 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:e46.

2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372:11.

3. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372:1019.

4. Pexman JH, Barber PA, Hill MD, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22:1534.