Groups Issue Guidance on Endovascular Repair of Ischemic Stroke — Physician’s First Watch
Groups Issue Guidance on Endovascular Repair of Ischemic Stroke
By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH
Early endovascular therapy with a stent retriever — a self-expanding stent that can retrieve blood clots and restore circulation — is now recommended for certain patients with acute ischemic stroke, according to a guideline update from the American Heart Association and American Stroke Association.
In particular, such treatment should be performed in patients who meet all of these criteria:
had no significant disability before the stroke (modified Rankin scale score, 0-1);
received intravenous recombinant tissue-type plasminogen activator (r-tPA) within 4.5 hours of symptom onset;
have causative occlusion of the internal carotid artery or proximal middle cerebral artery;
are age 18 years or older;
experienced an acute, moderate-to-severe stroke (NIH Stroke Scale, 6 or higher);
have no permanent damage in over half the brain on the affected side, according to CT imaging;
can begin endovascular therapy within 6 hours after symptom onset.
The guidance, published in Stroke, emphasizes that intravenous r-tPA continues to be first-line treatment in such patients. Detailed recommendations for particular patient groups (e.g., those with occlusions in different arteries from those listed above) and new considerations for imaging are also provided.