LAST₂ CH₂ANCE: A Summary of Selection Criteria for Thrombectomy in Acute Ischemic Stroke

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 guidelines^3,4 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.

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.

• © 2017 by American Journal of Neuroradiology