Masterclass #10: M1 thrombectomies: frequency does not mean zero problems. So what are the questions?

Tommy ANDERSSON, Raul G. NOGUEIRA, Vitor MENDES PEREIRA, Jacques MORET, Laurent SPELLE

In 2015, “Big 5” trials underlined the efficacy of mechanical thrombectomy (MT) in dealing with M1 occlusions. The rules were clear then: a large vessel occlusion could be treated in less than six hours with stentrievers.

But today, with advances in our understanding and the evolution in technology and techniques, informed decisions have become more complex: do we consider NIHHS or Aspects Scores? Can a patient be treated more than 6 hours after onset?

In this Masterclass, Professors Jacques Moret and Laurent Spelle and their expert panel, through a series of specially chosen cases, help us navigate the New World of treating M1 occlusions:

• MRI or CT scan? Which would you use?
• What is the value of perfusion studies – and when would you use them?
• In cases of severe stroke, should IV fibrinolysis be performed before arriving at the stroke center?
• Ongoing trials – SWIFT DIRECT and MR CLEAN NO IV; the WE-TRUST study assessing the impact of direct to angio suite workflows on stroke patient outcomes.
• Which MT technique to use – a “BADASS”orfull technique involving a stentriever/balloon guiding catheter/aspiration catheter combo or a simpler approach?
• Radial or femoral access? Is there really a choice today?
• Aspiration devices – could new sizes be game changers?
• Would you perform MT without an anesthetist present?
• How should our healthcare systems be organized to offer optimum stroke care: centralized or decentralized? Specialists going to the patients or the patients to them?