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Thrombectomy Trials – Evidence Base — SCE Neurology MCQ

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EasyCerebrovascular DiseaseThrombectomy Trials – Evidence BaseSCE Neurology

A 50-year-old woman with an acute right MCA stroke is assessed for mechanical thrombectomy. CT angiography confirms a right M1 segment occlusion. Her NIHSS is 18. CT perfusion shows a large penumbra (ischaemic but salvageable tissue) surrounding a small core infarct. She is within the 6-hour window. What is the evidence for thrombectomy?

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Correct answer: D — The MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT trials demonstrated that mechanical thrombectomy significantly improves functional outcome (reduced disability at 90 days) for anterior circulation large vessel occlusion, with NNT of approximately 3–5

Five landmark RCTs (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT — all published 2015) showed clear benefit of mechanical thrombectomy for anterior circulation large vessel occlusion (ICA/M1). Key findings: NNT ~3–5 for improved functional outcome, benefit maintained up to 24 hours in selected patients (DAWN, DEFUSE-3 trials), thrombectomy is ADDED to IV thrombolysis (not a replacement — give alteplase then thrombectomy). A: Overwhelming evidence from 5+ RCTs. C: Primarily for anterior circulation, though basilar is emerging. D: Thrombectomy adds to IV thrombolysis. E: Effective within 6 hours (24 hours with perfusion imaging selection).

Reference: MR CLEAN/ESCAPE/EXTEND-IA/SWIFT PRIME/REVASCAT; NICE NG128