What is the maximum time window for onset-to-thrombectomy in this protocol?

What is the maximum time window for onset-to-thrombectomy in this protocol?

• A. 24 hours
• B. 4.5 hours
• C. 12 hours
• D. 6 hours

Answer: (A)

The main idea here is that the time window for thrombectomy can be longer than the early-hours cutoff when advanced imaging shows there is still salvageable brain tissue. In patients with a large vessel occlusion, perfusion imaging (CT or MRI) can reveal a small core infarct with a larger area at risk (penumbra). If this mismatch is present, thrombectomy can be beneficial even up to 24 hours from onset, based on trials like DAWN and DEFUSE 3. So, the maximum onset-to-thrombectomy window in this protocol is 24 hours, provided the imaging criteria are met. If the imaging shows a large core or little to no penumbra, the benefit may not be present even within that window.

The main idea here is that the time window for thrombectomy can be longer than the early-hours cutoff when advanced imaging shows there is still salvageable brain tissue. In patients with a large vessel occlusion, perfusion imaging (CT or MRI) can reveal a small core infarct with a larger area at risk (penumbra). If this mismatch is present, thrombectomy can be beneficial even up to 24 hours from onset, based on trials like DAWN and DEFUSE 3. So, the maximum onset-to-thrombectomy window in this protocol is 24 hours, provided the imaging criteria are met. If the imaging shows a large core or little to no penumbra, the benefit may not be present even within that window.