Late intra-arteriële behandeling van herseninfarcten

Klinische les
09-05-2019
Laura C.C. van Meenen, Miou S. Koopman, Yvo B.W.E.M. Roos, Bart J. Emmer, Charles B.L.M. Majoie en Jonathan Coutinho

Dames en Heren,

Sinds de publicatie van de resultaten van de MR CLEAN-studie in de New England Journal of Medicine in 2015, wordt bij patiënten met een herseninfarct en een proximale intracraniële arteriële occlusie van de voorste circulatie tot 6 h na het ontstaan van de symptomen intra-arteriële trombectomie (IAT) verricht.1 De recentere DAWN- en DEFUSE 3-studie hebben aangetoond dat IAT ook effectief is bij een geselecteerde groep patiënten bij wie uitvalsverschijnselen langer dan 6 h bestaan.2,3

Late endovascular treatment of acute ischemic stroke

Endovascular treatment (EVT) has become the standard of care for patients with acute ischemic stroke (AIS) due to large-vessel occlusion of the anterior circulation within 6 hours after the onset of symptoms. The recently published DAWN and DEFUSE 3 trials have shown that EVT is also effective beyond 6 hours after the onset of symptoms in patients who have been selected on the basis of CT perfusion imaging. We describe three cases of patients in whom we considered ‘late’ EVT on the basis of the results of these trials. Two female patients, 56 and 66 years old, both with large hemispheric AIS, were treated with EVT, respectively 8 and 15 hours after the onset of symptoms. Both patients had good clinical outcomes. In the third patient, a 79-year-old male, we decided to refrain from treatment with EVT on the basis of CT perfusion imaging. We describe our considerations with respect to these treatment decisions, our interpretation of the results of the DAWN and DEFUSE 3 trials and the implications of these results for the organization of stroke logistics in the Netherlands.

Conflict of interest and financial support: none declared.