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Ischemic Stroke
CASE REPORT
Revisiting the therapeutic time window dogma: successful thrombectomy 6 days after stroke onset
  1. Pedro Aguilar-Salinas1,
  2. Roberta Santos1,
  3. Manuel F Granja1,
  4. Sabih Effendi2,
  5. Eric Sauvageau1,
  6. Ricardo Hanel1,
  7. Amin Aghaebrahim1
  1. 1 Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  2. 2 Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Amin Aghaebrahim, Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA; amin.aghaebrahim{at}bmcjax.com

Abstract

Stroke is the leading cause of serious long-term disability in the USA. Recent clinical trials, DAWN and DEFUSE 3, have expanded the endovascular therapeutic time window which has been adopted by the American Heart Association stroke guideline. However, there continues to be a dilemma as to what is the best approach for patients who present beyond the time window set by these trials and the current guideline. The interval from arterial occlusion to completion of brain tissue infarction varies from patient to patient and depends on the actual time and also a physiological clock or a tissue time window. Offering endovascular treatment based solely on a rigid time criterion excludes patients who may have a clinical benefit because of potentially salvageable tissue. We present a case of a patient who underwent successful stroke thrombectomy 6 days after stroke onset.

  • stroke
  • thrombectomy
  • intervention
  • ct perfusion

https://doi.org/10.1136/neurintsurg-2018-014039.rep

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    Footnotes

    • Republished with permission from BMJ Case Reports. Published 16 7 2018; doi: 10.1136/bcr-2018-014039

    • Contributors PA-S and AA were responsible for study concept and design. MFG and RS contributed to acquisition of the data. All the authors were responsible for analysis and interpretation of the data. PA-S, RS, and MFG contributed to the drafting of the manuscript. ES, RH, and AA contributed to critical revision of the manuscript for important intellectual content. All the authors were responsible for administrative, technical and material support. AA contributed to study supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RH is a consultant for Medtronic, Stryker, Codman, and MicroVention. The other authors have nothing to disclose.

    • Patient consent Obtained.

    • Ethics approval BMC IRB, #16-58.

    • Provenance and peer review Not commissioned; externally peer reviewed.