The imperative for evidence-based clinical management of challenging clots in thrombectomy and acute ischemic stroke

Thrombectomy has emerged as a transformative treatment approach for acute ischemic stroke, offering new hope for patients and significantly improving outcomes. However, the management of challenging clots during thrombectomy procedures remains a not so rare and complex aspect of stroke care. In a recent 6104 patients analysis over a 7 years period, the ETIS group found that TICI2b rates have improved over time but reached a plateau after 2018 with still a >10% failure rate ( Bourcier et al 2023 ).

In this final newsletter, we delve into the critical need for evidence-based clinical management of tough clots, emphasizing the importance of refining treatment strategies and comparing techniques to optimize patient outcomes.

The Challenge of Challenging Clots

Challenging clots present a unique set of obstacles during thrombectomy procedures. These clots often exhibit distinct characteristics (defined by experts during the last CLOTS summit . Their presence poses a significant clinical challenge, as traditional treatment approaches may be less effective in achieving successful reperfusion. It is therefore crucial to develop evidence-based strategies specifically tailored to address the intricacies of managing tough clots.

Advancing Research for Improved Outcomes

To effectively manage challenging clots, there is an urgent need for further research and clinical trials focusing on specific strategies for this specific subgroup of patients. The NIMBUS™ stent was developed as an innovative solution for tough clots and was properly evaluated in the recently presented SPERO study . Pr. Franziska Dorn also shares here her personal experience integrating this tool in clinical practice.

Striving for Personalized Care

While evidence-based management serves as a foundation, it is essential to recognize that every patient is unique. Tailoring treatment approaches based on individual patient characteristics, such as clot composition and location, may further optimize outcomes.

Prospective registries like ARISE and EXCELLENT as well as the VECTOR randomized control trial will greatly contribute to a better understanding of the relations between occlusion types and the different first-line strategies outcomes.

Advancements in understanding the complexities of challenging clots will propel us closer to the goal of delivering precise and personalized care for every stroke patient. Together, let us forge ahead in our quest for evidence-based solutions, ensuring that no patient is left behind in the fight against stroke.

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