Expanding indications for endovascular thrombectomy-how to leave no patient behind
Peter B. Sporns, Jens Fiehler, Johanna M. Ospel, Apostolοs Safouris, Uta Hanning, Urs Fischer, Mayank Goyal, Ryan McTaggart, Alex Brehm, Marios Psychogios
Abstract
Endovascular thrombectomy (EVT) has become standard of care for large vessel occlusion strokes but current guidelines exclude a large proportion of patients from this highly effective treatment. This review therefore focuses on expanding indications for EVT in several borderline indications such as patients in the extended time window, patients with extensive signs of infarction on admission imaging, elderly patients and patients with pre-existing deficits. It also discusses the current knowledge on intravenous thrombolysis as an adjunct to EVT and EVT as primary therapy for distal vessel occlusions, for tandem occlusions, for basilar artery occlusions and in pediatric patients. We provide clear recommendations based on current guidelines and further literature.