In this post, I link to and post the show notes to Stroke Management Update (0:38-8:44) from EM Quick Hits 49*.
*Helman, A. Swaminathan, A. Reid, S. Petrosoniak, A. Toth,, P. Khatib, N. Wallace, J. Poyner, M. EM Quick Hits 49 – Stroke Management Update, Intussusception, 5 Penetrating Trauma Tips, Foreign Body Hack, Radiation Risk, Emergency Fund. June, 2023. https://emergencymedicinecases.com/em-quick-hits-june-2023/. Accessed June 11, 2023.
All that follows is from the show notes of EM Quick Hits 49.
The eligibility criteria of endovascular therapy for large vessel strokes may be expanding in the future
- Current guidelines indicate endovascular therapy (EVT) for large vessel occlusion strokes occurring within 24 hours of presentation with neuroimaging demonstrating a small ischemic core with a viable penumbra
- The ANGEL-ASPECT and SELECT2 RCTs published in 2023 suggested that patients presenting with large infarcted cores receiving EVT were found to have superior neurologic outcomes compared to medical management alone
- In the SELECT Late retrospective study, there additionally appeared to be a benefit of neurologic outcomes for patients receiving EVT despite presenting with large vessel strokes beyond 24 hours of “last known well”
- Although the mentioned studies suggest benefit for EVT beyond our current eligibility criteria, further studies are needed before applying the evidence to clinical practices as SELECT was a retrospective study and biases and limitations were present
Ep 120 ED Stroke Management in the Age of Endovascular Therapy
- Huo X, Ma G, Tong X, et al. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med. 2023;388(14):1272-1283. doi:10.1056/NEJMoa2213379
- Nogueira RG, et al. The Penumbra AngioJet System for Mechanical Thrombectomy in Acute Large Vessel Occlusion Stroke: The ANGEL-ASPECT Study. J Neurointerv Surg. 2022 Sep;14(9):878-883.
- Jovin TG, et al. Thrombectomy with Stent Retrievers and Adjuvant Medical Therapy for Acute Ischemic Stroke with Large Vessel Occlusion: The SELECT2 Trial. JAMA. 2021 Sep 7;326(9):875-884.
- Goyal M, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke with Early Computed Tomography Imaging: SELECT Late Trial. Stroke. 2021 Jan;52(1):127-135.
- Sarraj A, Hassan AE, Abraham MG, et al. Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med. 2023;388(14):1259-1271. doi:10.1056/NEJMoa2214403
