Goalposts for Stroke Thrombectomy Trials in Elderly Patients

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.

---

CHECK OUT OUR SPONSOR

MicroVention FRED X

https://www.fred-x.com/

---

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