When is mechanical thrombectomy indicated in acute stroke evaluation?

When is mechanical thrombectomy indicated in acute stroke evaluation?

• A. Only within 3 hours for all AIS patients
• B. In patients with a large vessel occlusion within 6 hours; extended window 6–24 hours in select patients with favorable perfusion imaging or meeting DAWN/DEFUSE-3 criteria
• C. For all ischemic strokes regardless of occlusion
• D. Only if tPA contraindicated

Answer: (B)

The key idea is that mechanical thrombectomy targets patients with acute ischemic stroke caused by a large vessel occlusion, where restoring blood flow quickly can save brain tissue and improve outcomes. The strongest evidence supports performing thrombectomy in the early hours after onset for eligible patients. If imaging shows a substantial amount of brain tissue at risk that is still salvageable, some patients can be treated in a later window as well, based on selective perfusion imaging findings or criteria from trials like DAWN and DEFUSE-3. In short, it's not for all ischemic strokes or all occlusions, and it can be used in conjunction with other therapies when appropriate.

The key idea is that mechanical thrombectomy targets patients with acute ischemic stroke caused by a large vessel occlusion, where restoring blood flow quickly can save brain tissue and improve outcomes. The strongest evidence supports performing thrombectomy in the early hours after onset for eligible patients. If imaging shows a substantial amount of brain tissue at risk that is still salvageable, some patients can be treated in a later window as well, based on selective perfusion imaging findings or criteria from trials like DAWN and DEFUSE-3. In short, it's not for all ischemic strokes or all occlusions, and it can be used in conjunction with other therapies when appropriate.