WSC 2022 | Debating the use of mechanical thrombectomy for patients with large ischemic strokes

Wim H. van Zwam, MD, Maastricht University Medical Center, Maastricht, The Netherlands, shares the arguments he presented at the World Stroke Congress 2022 as part of a debate on the use of mechanical thrombectomy (MT) for patients with large infarcts (ASPECTS 3-5). The 2019 ESO-ESMINT guidelines recommend the use of MT over best medical management alone in patients with a large vessel occlusion without evidence of extensive infarct core (eg, ASPECTS ≥6 on non-contrast CT). Given the very low quality of evidence, the guidelines recommended patients with extensive infarct core to be included in randomized controlled trials. Prof. van Zwam discusses recent data that supports the value of MT in this population, most strongly in the early time window. While most of this evidence comes from non-randomized registries or single arm studies, the 2022 RESCUE-Japan LIMIT trial (NCT03702413) also showed that patients with large cerebral infarctions had significantly better functional outcomes with endovascular therapy than with medical care alone. Randomized controlled trials enrolling patients with low CT-ASPECTS are underway, including TENSION (NCT03094715), LASTE (NCT03811769), TESLA (NCT03805308), and SELECT2 (NCT03876457). This interview took place at the World Stroke Congress 2022 in Singapore.

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