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BackTable / VI / Podcast / Episode #409
Thrombectomy for Large Core Infarctions: Balancing Benefits & Risks
with Dr. Fawaz Al-Mufti and Dr. Krishna Amuluru
In this episode of the BackTable Podcast, guest host Dr. Krishna Amuluru interviews Dr. Fawaz Al-Mufti about recent trials on large core strokes and how they may impact practice. Dr. Al-Mufti is a practicing neurointerventionalist and serves as the Associate Chair of Neurology for Research at New York Medical College.
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BackTable, LLC (Producer). (2024, January 24). Ep. 409 – Thrombectomy for Large Core Infarctions: Balancing Benefits & Risks [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
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
Dr. Krishna Amuluru is a neurointerventional radiologist with Goodman Campbell Brain and Spine in Indianapolis, Indiana.
Synopsis
Dr. Al-Mufti examines the cost-effectiveness and socioeconomic implications of successful treatment of patients with large core strokes. The doctors highlight various stroke thrombectomy trials including the RESCUE-Japan, SELECT2 Trial, and TENSION trials. The discussion also covers how these findings affect thrombectomy expansion in lower resource settings and the future outlook of endovascular thrombectomy procedures.
Timestamps
00:00 - Introduction
02:53 - Large Ischemic Core Infarcts
06:06 - The Importance of ASPECTS
11:59 - Large Ischemic Core Trials
23:37 - Socioeconomic Implications of Thrombectomy
38:08 - The Future of Thrombectomy
Resources
Mission Thrombectomy:
https://missionthrombectomy.org/
The Alberta Stroke Program Early CT score (ASPECTS): A predictor of mortality in acute ischemic stroke:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515558/
Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials (HERMES Study):
https://doi.org/10.1016/S0140-6736(16)00163-X
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging (DEFUSE III Trial):
https://www.nejm.org/doi/full/10.1056/nejmoa1713973
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN Trial):
https://www.nejm.org/doi/full/10.1056/nejmoa1706442
Endovascular Therapy for Acute Stroke with a Large Ischemic Region (RESCUE-Japan Trial):
https://www.nejm.org/doi/full/10.1056/nejmoa2118191
Trial of Endovascular Thrombectomy for Large Ischemic Strokes (SELECT2 Trial):
https://www.nejm.org/doi/full/10.1056/NEJMoa2214403
TESLA Trial: Rationale, Protocol, and Design:
https://www.ahajournals.org/doi/10.1161/SVIN.122.000787
Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomized trial (TENSION Trial):
https://www.sciencedirect.com/science/article/pii/S0140673623020329
Evaluation of acute mechanical revascularization in large stroke (ASPECTS ⩽5) and large vessel occlusion within 7 h of last-seen-well: The LASTE multicenter, randomized, clinical trial protocol:
https://pubmed.ncbi.nlm.nih.gov/37462028/
Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct (ANGEL-ASPECT Trial):
https://www.nejm.org/doi/full/10.1056/NEJMoa2213379
Acute endovascular stroke therapy (Dr. Mike Chen Review):
https://pubmed.ncbi.nlm.nih.gov/20535000/
Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS (European Cost Effectiveness Study):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/
Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10313965/
Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576630/
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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