Stroke Thrombectomy: Strict Mismatch Criteria Not Necessary After 16 Hours?

[nikolaite]

Looser imaging criteria would open door to wider eligibility

I’ve been seeing some new publications on EVT criteria these past few weeks, and with the study I’m on, this article was at least worth reading. What do others in this sub forum think on this, just based on your experience with 90-day outcomes? Have you seen any sub-6 (NIHSS) pts who received EVT with better 90-day outcomes than you would predict based on a conservative approach?

Thanks in advance.

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[deathmerchant]

Looser imaging criteria would open door to wider eligibility

I’ve been seeing some new publications on EVT criteria these past few weeks, and with the study I’m on, this article was at least worth reading. What do others in this sub forum think on this, just based on your experience with 90-day outcomes? Have you seen any sub-6 (NIHSS) pts who received EVT with better 90-day outcomes than you would predict based on a conservative approach?

Thanks in advance.

I don't think it means what your subject says. It means you need EITHER clinical OR Imaging mismatch. So you still have to demonstrate mismatch after 16 hours. I though that was the general consensus already now.

Also nowhere did they talk about sub 6 NIH in the article. Its NIH>6. And yes there are some isolated cases where a sub NIH 6 could potentially benefit from EVT, esp an evolving stroke or one with large mismatch.
But current recommendations are to manage most low NIHSS (esp non disabling) conservatively. Good stroke management is very individualized and depends on many factors and honestly its hard to make generalizations.

 

[ASA81QD]

AURORA doesn't change what most stroke centers are doing these days - extending the more liberal perfusion mismatch criteria to the 6-24 hour window as opposed to the 6-16 hour window (per DEFUSE 3) with NIH >6. Still, it's nice to have data backing up this practice.

Thrombectomy on <6 NIHSS patients remains debated, but yes most people manage this conservatively. Ongoing studies like ENDOLOW and MOSTE should help clear up this grey area. Like deathmerchant said, it should be a very individualized approach to these patients.

 

[nikolaite]

Thank you both for your responses.