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Indications for Mechanical Thrombectomy-Too Wide or Too Narrow?

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机构: [1]Department of Neurosurgery, Tampa, Florida, USA [2]Department of Neurology, University of South Florida, Tampa, Florida, USA [3]Department of Interventional Neurology, Capital Medical University, Beijing, China [4]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China [5]Center for Cerebrovascular Diseases, Taihe Hospital, Shiyan, Hubei, China
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关键词: Indication Mechanical Stroke Thrombectomy

摘要:
The indications for mechanical thrombectomy (MT) have expanded since the American Heart Association/American Stroke Association reported its first guidelines for MT in 2013. Multiple subsequent randomized clinical trials of MT have proved its efficacy, including the DAWN (DWI [diffusion weighted imaging] or CTP [computed tomography perfusion] Assessment with Clinical Mismatch in the Triage of Wake-ttp and Late Presenting Strokes Undergoing Neuro-intervention with Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke-3) trials. The current guidelines from the American Heart Association/American Stroke Association provide class I support for the use of MT for the following indications: 1) internal carotid artery (ICA)/M1 middle cerebral artery (MCA) occlusion, symptom onset <6 hours, National Institutes of Health Stroke Scale score of >= 6, Alberta Stroke Program Early Computed Tomography Score of >= 6; and 2) large vessel occlusions in the anterior circulation, symptom onset 6-16 hours, and meeting the DAWN or DEFUSE-3 eligibility criteria. Class Ila evidence is also available for the use of MT for large vessel occlusions in the anterior circulation, symptom onset 16-24 hours, and meeting other DAWN eligibility criteria. In clinical practice, these class I and Ila indications for MT have been well followed. However, many other potential indications are available, including 1) M2 or M3 MCA occlusion, symptom onset <6 hours; 2) Alberta Stroke Program Early Computed Tomography Score <6, ICA or M1 MCA occlusion, symptom onset <6 hours; 3) National Institutes of Health Stroke Scale score <6, ICA or M1 occlusion, symptom onset <6 hours; 4) tandem occlusions; and 5) posterior circulation occlusion <6 hours. The present review analyzed the available data to provide support for further prospective clinical trials regarding these potential indications.

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出版当年[2018]版:
大类 | 3 区 医学
小类 | 3 区 外科 4 区 临床神经病学
最新[2025]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 外科
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出版当年[2017]版:
Q2 SURGERY Q3 CLINICAL NEUROLOGY
最新[2023]版:
Q2 SURGERY Q3 CLINICAL NEUROLOGY

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第一作者机构: [1]Department of Neurosurgery, Tampa, Florida, USA [5]Center for Cerebrovascular Diseases, Taihe Hospital, Shiyan, Hubei, China
通讯作者:
通讯机构: [1]Department of Neurosurgery, Tampa, Florida, USA [5]Center for Cerebrovascular Diseases, Taihe Hospital, Shiyan, Hubei, China
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