Acute endovasculaire trombectomie bij herseninfarct: Uitbreiding van het indicatiegebied?

Endovascular thrombectomy for large vessel occlusion ischemic stroke is one of the most effective treatments in medicine in the past few years, despite a serious risk of reperfusion bleeding. The Dutch guideline recommended treating patients within 6-24 hours from onset only in case of an infarct core 25 ml or less and a penumbra of at least the same size. These criteria need modification, considering the results of ANGEL-ASPECT, SELECT2 AND MR CLEAN LATE.Thrombectomy in several patients whose intervention was previously thought to be futile or dangerous has now been proven highly effective. The criteria for treatment in the later time window (> 6 hours since onset) are not very easy to implement, but here the recently published MR CLEAN LATE can offer solace: it confirmed that selection of patients in the late time window can be based on collateral circulation, so that ASPECT score and CT perfusion no longer have to be decisive.