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American Stroke Association extends guidelines for clot retrieval up to 24 hours from onset of acute stroke

Exciting results from two major randomised controlled trials on mechanical thrombectomy were released at the International Stroke Conference 2018, the premier annual conference held by the American Stroke Association on January 24 – 26, 2018. There has been a dramatic change in management of large vessel occlusion ischaemic strokes (strokes due to blockage of major arteries in the brain) with use of stent retrievers since 2015 when the major stroke trials were published in New England Journal of Medicine. These demonstrated an overwhelming improvement in patients who had mechanical thrombectomy (also known endovascular clot retrieval), if treated within 6 hours of stroke onset. Two multi-centre randomised trials were conducted subsequently investigating the effectiveness of endovascular clot retrieval from 6 – 16 hours (DEFUSE-3 trial) and 6 – 24 hours (DAWN trial) after onset of stroke. Both trials were stopped early after pre-determined interim analyses were performed demonstrating a statistically significant better outcome in patients who had clot retrieval treatment. The overwhelming benefit seen in both trials (Number needed of patients needed to treat for significant improvement was 2) have resulted in a major update to the American Stroke Association guidelines. Based on appearances on CT scan, patients with large vessel strokes can still benefit up to 24 hours if there has not been substantial damage already incurred, and enough survivable brain tissue still present. Dr Wong was actively involved and participated as operating surgeon in the DEFUSE-3 trial, which was coordinated by Stanford University as the primary investigator site during his fellowship training in Neurointerventional Radiology between 2015 - 2017. Dr Wong also recently attended the International Stroke Conference 2018, in which the findings of DEFUSE-3 were presented.