Individualizing Endovascular Treatment in Acute Ischemic Stroke: Yasha Kayan, MD

WATCH TIME: 3 minutes

“Decisions to treat cannot be based on age or imaging alone. You have to consider how the patient was functioning before the stroke, how complex the procedure will be, and whether the risks truly outweigh the potential benefit.”

Endovascular therapy has become a cornerstone in the management of acute ischemic stroke, particularly following landmark trials demonstrating the efficacy of mechanical thrombectomy in patients with large vessel occlusion. Advances in imaging selection and workflow optimization have expanded treatment windows beyond traditional time-based criteria, allowing clinicians to consider intervention up to 24 hours after symptom onset.¹ This shift has emphasized a move toward more individualized, tissue-based decision-making.

Despite these advances, patient selection for endovascular intervention remains complex, particularly in extended time windows where clinical and imaging factors must be carefully balanced. Variables such as infarct core size, collateral circulation, and baseline functional status all play a role in determining whether a patient is likely to benefit from intervention.² At the same time, growing experience in neurointerventional practice has highlighted the importance of procedural considerations, including vascular anatomy, clot location, and technical complexity, which may significantly influence outcomes and overall risk.³

Yasha Kayan, MD, medical director of neurointerventional surgery at Allina Health Brain and Spine Institute, spoke with NeurologyLive® about how clinicians approach patient selection for endovascular therapy. In the discussion, he outlines key clinical and procedural factors, including age, baseline function, infarct burden, and technical complexity, and explains how these considerations shape treatment decisions in both early and extended time windows.

REFERENCES
1. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21. doi:10.1056/NEJMoa1706442
2. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708-718. doi:10.1056/NEJMoa1713973