In 2015 and 2016, six randomized controlled trials (MR CLEAN, ESCAPE, SWIFT PRIME, REVASCAT, EXTEND-IA, and THRACE), which focused on the endovascular treatment of patients with acute ischemic stroke caused by large vessel occlusion, were published in The New England Journal of Medicine1 and Lancet Neurology.2 All of these trials favor thrombectomy for patients with acute ischemic stroke with large vessel occlusion, which can significantly improve patients' 90-day outcomes. The impact of these trials is huge. Cerebrovascular physicians all over the world have started putting more efforts on thrombectomy. However, there are many indications and contraindications for thrombectomy, which are a challenge for the physician to remember and may cause potential errors and delays in the process of selecting candidates.
To handle this problem, we carefully reviewed the literature and guidelines3,4 and summarized the indications and contraindications as “LAST2 CH2ANCE,” which represents different aspects of patient selection. The details of “LAST2 CH2ANCE” are shown in the Table.
Details of LAST2 CH2ANCE
| Symbol | Meaning | Details |
|---|---|---|
| L | Large vessel occlusion | Internal carotid artery or proximal MCAa |
| A | Age | ≥18 yrsa |
| S | Symptom | NIHSS score ≥6a |
| T | Time | Onset to groin puncture time <6 ha |
| T2 | Thrombocytopenia | PLT ≥40*109/Lb |
| C | Crippled/disabled | mRS <2a |
| H | Hypoglycemia | CBG ≥2.7 mmol/Lb |
| H2 | Hypertension | BP ≤185/110 mmHgb |
| A | Anticoagulation | INR ≤3.0b |
| N | Nonsalvageable brain tissue | ASPECTS ≥6a |
| C | Collateral | ACG >1c |
| E | Expectancy of life | >90 db |
Note:—ACG indicates American Society of Interventional and Therapeutic Neuroradiology collateral grading; BP, blood pressure; CBG, capillary blood glucose; INR, international normalization ratio; PLT, platelet count.
Criterion from the American Heart Association/American Stroke Association guidelines.
Criterion from the protocol of MR CLEAN trial.
Criterion we use in our daily practice but without consensus in the literature.
We have used this to do many training sessions in China. During the posttraining survey, most physicians were impressed by this summary. They can remember complex patient selection criteria in a few minutes even though they knew very little before the training. Therefore, we feel it is better to let the entire community know this system to make rapid and accurate patient selection for thrombectomy. Because thrombectomy is the last chance for patients with acute ischemic stroke with large vessel occlusion to recover, we hope this patient selection summary, “LAST2 CH2ANCE,” will be helpful.
References
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