Mechanical Thrombectomy in Acute Ischemic Stroke Clinical Practice Guidelines (2019)

European Stroke Organisation

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 02, 2019

Guidelines on mechanical thrombectomy in acute ischemic stroke were published in February 2019 by the European Stroke Organisation.[1]

Mechanical thrombectomy (MT) plus best medical management (BMM) is recommended for adults with anterior circulation large vessel occlusion-related acute ischemic stroke presenting within 6 hours after symptom onset.

MT plus BMM is recommended for adults with anterior circulation large vessel occlusion-related acute ischemic stroke presenting between 6 and 24 hours from time last known well and fulfilling the inclusion criteria for the DEFUSE-3 and DAWN clinical trials.

Intravenous (IV) thrombolysis plus MT is recommended for patients with large vessel occlusion-related ischemic stroke. Both treatments should be performed as soon as possible after the patient arrives to the hospital.

MT plus BMM (including IV thrombolysis when indicated) is recommended for patients ≥ 80 years with large vessel occlusion-related acute ischemic stroke presenting within 6 hours of symptom onset.

MT plus BMM (including IV thrombolysis when indicated) is recommended in the 0–6-hour time window for patients with large vessel occlusion-related anterior circulation stroke without evidence of extensive infarct core.

MT plus BMM (including IV thrombolysis when indicated) is recommended in the 6–24-hour time window for patients with large vessel occlusion-related anterior circulation stroke who fulfill the inclusion criteria for the DEFUSE-3 and DAWN clinical trials.

Advanced imaging is not necessary for patient selection in adult patients with anterior circulation large vessel occlusion-related acute ischemic stroke presenting from 0–6 hours from time last known well. Advanced imaging is necessary in this group, however, if patients present beyond 6 hours from time last known well.

For more Clinical Practice Guidelines, go to Guidelines.

For more information, go to Ischemic Stroke.

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