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BackTable / VI / Podcast / Episode #360

Stroke Thrombectomy in Special Populations

with Dr. Fawaz Al-Mufti and Dr. Krishna Amuluru

In this episode, guest host and neurointerventional surgeon Dr. Krishna Amuluru interviews triple-boarded neurointerventional surgeon, neurointensivist, and neurologist Dr. Fawaz Al-Mufti about stroke thrombectomy in special populations.

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Stroke Thrombectomy in Special Populations with Dr. Fawaz Al-Mufti and Dr. Krishna Amuluru on the BackTable VI Podcast)
Ep 360 Stroke Thrombectomy in Special Populations with Dr. Fawaz Al-Mufti and Dr. Krishna Amuluru
00:00 / 01:04

BackTable, LLC (Producer). (2023, August 28). Ep. 360 – Stroke Thrombectomy in Special Populations [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Fawaz Al-Mufti discusses Stroke Thrombectomy in Special Populations on the BackTable 360 Podcast

Dr. Fawaz Al-Mufti

Dr. Fawaz Al-Mufti is the director of neuroendovascular surgery fellowship at Westchester Medical Center / New York Medical College.

Dr. Krishna Amuluru discusses Stroke Thrombectomy in Special Populations on the BackTable 360 Podcast

Dr. Krishna Amuluru

Dr. Krishna Amuluru is a neurointerventional radiologist with Goodman Campbell Brain and Spine in Indianapolis, Indiana.

Show Notes

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.

Resources

SVIN 2023 Annual Meeting:
https://www.svin.org/i4a/pages/index.cfm?pageid=3625

IMS-III Trial 2013:
https://www.nejm.org/doi/full/10.1056/nejmoa1214300

Mr. Clean Study:
https://www.nejm.org/doi/full/10.1056/nejmoa1411587

REVASCAT Study:
https://www.nejm.org/doi/full/10.1056/nejmoa1503780

EXTEND-IA Study:
https://www.nejm.org/doi/full/10.1056/nejmoa1414792

ESCAPE Trial:
https://www.nejm.org/doi/full/10.1056/nejmoa1414905

SWIFT PRIME Trial:
https://www.nejm.org/doi/full/10.1056/nejmoa1415061

HERMES Registry:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00351-2/fulltext?rss%3Dyes

Thrombolysis in Pediatric Stroke Study (TIPS):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342311/

Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke Study:
https://www.ahajournals.org/doi/10.1161/strokeaha.108.519066#:~:text=Analysis%20of%20Delay%20in%20Arterial,and%2020%25%20within%206%20hours.

Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke Study:
https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036361

Recanalization Treatments for Pediatric Acute Ischemic Stroke in France (Kids-Clot):
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796278

Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke: The Save ChildS Study:
https://pubmed.ncbi.nlm.nih.gov/31609380/

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee:
https://jnis.bmj.com/content/14/10/1033

O-039 diameters of large vessels in children and compatibility with adult interventional stroke devices: children are not little adults:
https://jnis.bmj.com/content/7/Suppl_1/A21.1

Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke: A Multi-Institutional Experience of Technical and Clinical Outcomes:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8660626/#bib28

WEB Device from Microvention TERUMO:
https://www.microvention.com/products/web-family

For complete indications, contraindications, potential complications, warnings, precautions, and instructions, see instructions for use provided in the device. WEB is intended for healthcare professional use only and by prescription only. Federal law restricts this device to sale by or on the order of a physician.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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