Clinical considerations and assessment of risk factors when choosing endovascular thrombectomy for acute stroke

ABSTRACT

Introduction

The advent of endovascular thrombectomy (EVT) has been a game changer for the management of acute ischemic stroke due to large vessel occlusion. However, the selection of suitable candidates for EVT remains a significant challenge.

Areas covered

This review focuses on the clinical, radiological, and procedural considerations for EVT in acute stroke that assist in optimal patient selection.

Expert opinion

All patients presenting with significant clinical deficits with treatable occlusions, who have salvageable brain tissue at presentation might benefit from treatment up to twenty-four hours from symptom onset. Neuroimaging tools form the backbone for this decision making.

KEYWORDS:

• Acute Ischemic stroke
• CT perfusion
• decision making
• endovascular thrombectomy
• multiphase CT angiography

Article highlights

• Prehospital management is vital in screening and selection of candidates for EVT.

• Noncontrast CT and angiography serve as vital modalities to quickly ascertain the degree of ischemia, site of vessel occlusion and collateral status. Perfusion may be most useful for selecting candidates for EVT who present with acute stroke outside the conventional window for thrombolysis.

• The decision to proceed to EVT should incorporate a combination of interrelated factors, including time since symptom onset, premorbid status, stroke severity, occlusion site, degree of early ischemia or infarct, extent of collaterals, and assessment of the size of core volume and penumbra.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.