Stroke Thrombectomy in Special Populations

Fawaz serves as an Associate Professor, Director of Neuroendovascular Surgery Fellowship & Neurocritical-Care Unit, Assistant Dean of GME research, and Vice-Chair of Neurology research at New York Medical College, Westchester Medical Center.

First, we define the special populations that have been excluded from stroke thrombectomy randomized controlled trials (RCTs). These populations include octogenarian, nonagenarian, pediatric, and pregnant patients.

Fawaz then recaps the landmark trials that have shaped the field of neuroendovascular surgery, beginning with the handful that were published in 2015/2016. Approaching mechanical stroke thrombectomy in patients in their 80s and 90s and the lack of existing RCT literature is also discussed.

Switching gears, Fawaz then speaks on caring for pediatric patients with large-vessel occlusion (LVO). Krishna and Fawaz cover the relative rarity of pediatric LVOs, significant differences in adult vs. pediatric stroke, and what literature exists to help guide decision-making in this patient population.

Krishna then asks Fawaz about mechanical stroke thrombectomy in pregnant patients. They also cover existing literature, etiologies, and their approaches to intervention. To conclude the episode, Fawaz and Krishna speak on the purposes, applications, extrapolations, and limitations of randomized-controlled trials.