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Mechanical thrombectomy makes a comeback in treating acute ischemic stroke - The Stroke Blog
Intravenous (IV) t-PA, a “clot-busting” drug approved by the FDA for the treatment of acute ischemic stroke within three hours of the start of symptoms, has been recognized as the standard of care since the pivotal NINDS clinical trial that demonstrated reduced level of disability 90 days after ischemic stroke in eligible patients who received it. However, the subject of acute treatment with the use of thrombectomy has remained controversial until recently. Thanks to recent clinical trial results, the American Heart Association/American Stroke Association guidelines have now been updated recommending the use of this procedure in eligible patients meeting appropriate criteria. Depending on the geographical region and practices, approximately one to 25% of acute ischemic stroke patients will receive IV t-PA, with the national average being around six to ten percent. Questions that have continued to plague physicians delivering care to this patient population include: What, if anything, can be offered to patients who are not eligible for IV t-PA, but who still present to the hospital within hours of stroke onset? What should be done for patients who have received IV t-PA, but who are failing to improve clinically, and there is a known blood clot that remains in a …