Experts believe that expanding access of thrombectomy to individuals with higher levels of irreversible brain damage could mean that thousands of patients could have the possibility to achieve functional independence.
According to commentary published in the Journal of NeuroInterventional Surgery, by opening access to thrombectomy to individuals who have experienced a large vessel occlusion, it would offer them a better chance of regaining essential cognitive and physical functions.
“Large Core Stroke Thrombectomy: Paradigm Shift of Futile Exercise?” Cites the results of three randomised clinical trials that display mechanical thrombectomy significantly improves the functional outcomes and likelihood of independence in patients who arrived at hospital with larger amounts of irreversible damage (infarct core) prior to the procedure.
In these recent trials, patients were up to three times more likely to have a positive outcome with thrombectomy than those without.
Earlier trials of thrombectomy had shown dramatic benefit in those patients with small and medium sized infarct cores, however, the possible benefit of thrombectomy on larger core patients remained unknown.
The three latest trials (RESCUE Japan LIMIT, SELECT2 and ANGEL-ASPECT) evaluated individuals with a sizeable amount of core damage and randomised them to either thrombectomy or medical management.
Results determine that there is a clear benefit of thrombectomy for these patients, who likely would have been bedridden without the treatment.
Dr J Mocco, President and the Kalmon D. Post Professor of Neurosurgery at the Icahn School of Medicine and Director of the Cerebrovascular Center at Mount Sinai hopes that the results of these publications will lead to more thrombectomy transfers, simpler imaging for identifying candidates and, most importantly, a cumulative reduction in the degree of stroke disability and burden to patients and their loved ones.
Dr Mocco, says: “One of the biggest concerns patients and their families have about stroke is that they will be bedridden and fully dependent on others for care. Now we have an opportunity to improve functional independence for even the most severe stroke patients.
“These findings further support the notion that every patient should be triaged to the most appropriate care so they are given a chance to survive and thrive.”
