Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee

Abstract

Table 1 Randomized trials and registries of modern approaches to thrombectomy Trial no of patients, total/Ia (when applicable) lVo location Time window for thrombectomy, hours Stroke severity (nIhSS score) Imaging criteria Treatment groups mrS score=0-2 at 90 days Randomized trials: Endovascular vs medical MR CLEAN 8 500/223 ICA, M1, M2, A1, A2 0-6 2 No limit Endovascular arm: stent retrievers in 97% of IA cases, 87% of IA-treated patients received IV rtPA first. Control arm: IV rtPA in 91% of patients Endovascular group: 33% Control group: 19% NNT=7.1 ESCAPE 13 215/165 ICA, M1, both (all) M2s 0-12 'Disabling' symptoms but no strict NIHSS limit CT ASPECTS 6-10, moderate-to-good collateral status on mCTA Endovascular arm: stent retrievers in 86% of all IA cases. 73% of IA-treated patients received IV rtPA first Control arm: IV rtPA in 79% of patients Endovascular group: 53% Control group: 29% NNT=4.2 EXTEND-IA 9 70/35 ICA, M1, M2 0-6 No limit CTP/MRP core <70 mL Endovascular arm: IV rtPA plus Solitaire stent retriever in all IA cases. Control arm: IV rtPA in all Endovascular group: 71% NNT=3.2 SWIFT PRIME 10 196/98 ICA, M1 0-6 8-29 CTP/MRP core 50 mL, CT/MRI ASPECTS 6-10 Endovascular arm: IV rtPA plus Solitaire stent retriever in all IA cases. Control arm: IV rtPA in all Endovascular group: 60% Control group: 35% NNT=4