SNIS 2019: It is “almost unethical” not to broaden thrombectomy inclusion criteria and treat more patients


Donald Frei (Denver, USA) talks to BLearning at SNIS 2019 (22–25 July, Miami, USA) to discuss recent data from the cohort of thrombectomy trials which has shown a “benefit” for stroke patients with lower ASPECTS (Alberta Stroke Program Early CT Scores). “What we will see from the next round of studies,” says Frei, is that “there will be patients that can benefit even with larger core infarcts”.

Frei emphasises that inclusion criteria should “absolutely” be broadened to treat more patients, adding that “we have one of the most powerful, if not the most powerful treatment in medicine available to us”. As such, Frei notes that “it is almost unethical not to treat as many patients as we can”.

Frei also looks at the downsides of treating large stroke and low ASPECTS large vessel occlusion with thrombectomy, including patients having “a higher risk of having a reperfusion haemorrhage” or a “malignant oedema”.

The ultimate goal, says Frei, is to “prove that low ASPECTS core infarcts patients will benefit from thrombectomy. We need to think about “treating every patient we see” and must have an “extremely good reason not to offer a patient this therapy”, he adds.


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