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Until recently, endovascular therapy for schemic stroke has generally been limited to patients with a small infarcted core and a big penumbra. That's the surrounding salvageable

tissue, which makes sense. The question is, does endovascular therapy benefit those patients with

big infarcted cores? Here's Swami to give us the answer based on the latest studies.

The end of 2014 into 2015 was a critical turning point for stroke management. In December 2014,

we saw the publication of the Mr. Clean trial.

This is the first publication, first study to show that endovascular therapy could

offer benefits to patients, specifically those with large vessel occlusion strokes.

Over the next couple of years, we saw a slew of publications echoing these findings

and subsequently expanding indications and time windows.

Our current guidelines recommend endovascular therapy be undertaken in patients presenting

with a large vessel occlusion defined as occlusion of the internal carotid artery,

middle cerebral artery, and anterior cerebral artery occurring within 24 hours of presentation where advanced imaging shows a

small ischemic core within at-risk but viable penumbra. These recommendations have forced

us to change our triage to screen for those who could have an LVO within 24 hours.

We do this typically by looking for an NIHSS greater than are equal to six or by using a VAN

score, and then moving forward with non-conhead CT, CT Angio, and then either CT or MR perfusion.

It's nice that we've settled into this approach, but of course, as data emerges,

things continue to change. There's been a handful of recent publications that are important

...