Clinical Scorecard: Reperfusion Strategies in Imaging-Selected Ischemic Stroke: Analyzing Thrombolysis and Mechanical Thrombectomy Outcomes in the Late Window
At a Glance
Category
Detail
Condition
Ischemic Stroke
Key Mechanisms
Mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) for anterior circulation proximal large-vessel occlusion (LVO) stroke.
Target Population
Imaging-selected patients with anterior circulation LVO treated 6 to 24 hours after last known well time.
Care Setting
Systems-of-care framework for late-window stroke management.
Key Highlights
MT is superior to medical therapy for anterior circulation proximal LVO stroke.
Late-window IVT trials (TRACE-III, HOPE) show benefits in imaging-selected patients.
No randomized head-to-head trials exist comparing late-window IVT and MT.
Baseline prognosis and occlusion site significantly affect treatment outcomes.
Treated-arm outcomes should be interpreted within each trial context.
Guideline-Based Recommendations
Diagnosis
Identify anterior circulation proximal LVO using imaging.
Management
Consider MT for eligible patients within 6 to 24 hours of LKW.
Use IVT when MT is unavailable or delayed.
Monitoring & Follow-up
Assess functional independence using modified Rankin Scale (mRS) at 90 days.
Risks
Monitor for symptomatic intracranial hemorrhage (sICH) and mortality.
Patient & Prescribing Data
Patients with anterior circulation LVO, treated 6 to 24 hours after LKW.
Outcomes vary significantly based on baseline stroke severity and occlusion characteristics.
Clinical Best Practices
Evaluate treatment efficacy by comparing outcomes within the same trial.
Avoid informal comparisons of treated-arm outcomes across different trials.
