Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet, 404(10459), 1265–1278. https://doi.org/10.1016/S0140-6736(24)01410-7 Dr. Thanh N Nguyen et al.
Points
- Large vessel occlusion (LVO) stroke is a significant cause of disability and mortality, with endovascular therapy proving effective in reducing these outcomes.
- Recent advancements have expanded the treatment window to include patients beyond 6 hours from symptom onset, those with basilar artery occlusion, and those with large ischemic cores.
- Fundamental questions remain about which patients benefit most from endovascular therapy, especially those with large infarcts or lower NIHSS scores.
- Managing patients with underlying intracranial atherosclerosis requires further study, as they may have different therapeutic needs compared to those without such comorbidities.
- There is increasing interest in cytoprotective and adjunctive therapies to slow infarct progression, improve reperfusion, and reduce complications, which could enhance outcomes for LVO stroke patients.
Summary
Large vessel occlusion (LVO) stroke is a significant cause of disability and mortality globally, with endovascular therapy emerging as an effective treatment option to reduce these outcomes. Recent advancements have expanded the treatment window to include patients beyond 6 hours from symptom onset, those with basilar artery occlusion, and those presenting with large ischemic cores. These developments allow for simplified imaging and have made it possible to treat more patients. However, questions remain about which patients with large ischemic infarcts are most likely to benefit from endovascular therapy and the role of this intervention in patients with lower National Institutes of Health Stroke Scale (NIHSS) scores or more distal vessel occlusions.
One area of focus is the application of endovascular therapy to patients with varying degrees of ischemic burden. Studies are still needed to determine which individuals, particularly those with large infarcts at presentation, could benefit from the procedure without exacerbating risks. Additionally, it is not yet fully understood how to best manage patients with underlying intracranial atherosclerotic disease, who may have different therapeutic needs compared to those without such comorbidities. Current practice typically involves intravenous thrombolysis, mechanical thrombectomy, or a combination of both to restore blood flow and limit tissue damage.
As research in this field progresses, there is growing interest in cytoprotective and adjunctive therapies aimed at slowing infarct progression, improving reperfusion, and reducing hemorrhagic complications. If successful, these therapies could enhance outcomes in LVO stroke patients undergoing endovascular intervention. While current techniques show promise, optimizing treatment strategies by further investigating adjunctive therapies and patient selection criteria is essential to maximizing patient outcomes.
Link to the article: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01410-7/abstract
References Nguyen, T. N., Abdalkader, M., Fischer, U., Qiu, Z., Nagel, S., Chen, H.-S., Miao, Z., & Khatri, P. (2024). Endovascular management of acute stroke. The Lancet, 404(10459), 1265–1278. https://doi.org/10.1016/S0140-6736(24)01410-7
