Ep. 409 Thrombectomy for Large Core Infarctions: Balancing Benefits and Risks with Dr. Fawaz Al-Mufti

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.

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.

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SHOW NOTES

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

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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/