Mechanical Thrombectomy Guidelines Quiz
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Questions and Answers

What is the standard of care for acute ischaemic stroke patients with large vessel occlusion?

  • Surgical intervention
  • Medical management
  • Mechanical thrombectomy (correct)
  • Radiation therapy

    • When is mechanical thrombectomy plus best medical management recommended for LVO-related acute ischaemic stroke patients?

  • Within 6 hours after symptom onset (correct)
  • Within 24 hours after symptom onset
  • Within 12 hours after symptom onset
  • Within 48 hours after symptom onset

    • When is mechanical thrombectomy plus best medical management recommended for LVO-related acute ischaemic stroke patients in the 6-24 hour time window?

  • For patients meeting the eligibility criteria of published randomized trials (correct)
  • For patients with extracranial carotid artery stenosis or occlusion
  • For patients with low stroke severity or large infarct volume
  • For all patients with LVO-related acute ischaemic stroke

    • What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What further randomized trials are needed to inform clinical decision-making regarding MT?

    <p>Mothership and drip-and-ship approaches</p> Signup and view all the answers

    What imaging is recommended for all patients suspected of having an acute stroke?

    <p>Emergency imaging of the brain, including vascular imaging</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients eligible for both IVT and MT?

    <p>IVT plus MT</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients not eligible for IVT?

    <p>MT alone</p> Signup and view all the answers

    Is there evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>No</p> Signup and view all the answers

    Which model may be favored in metropolitan areas for MT?

    <p>The mothership model</p> Signup and view all the answers

    Is there an upper age limit for MT?

    <p>No</p> Signup and view all the answers

    What patient selection criteria may be used for MT?

    <p>Age, severity or infarct core volume, and type of neurological impairment, among others</p> Signup and view all the answers

    What is the standard of care for acute ischaemic stroke patients with large vessel occlusion?

    <p>Mechanical thrombectomy</p> Signup and view all the answers

    When is mechanical thrombectomy plus best medical management recommended for LVO-related acute ischaemic stroke patients?

    <p>Within 6 hours after symptom onset</p> Signup and view all the answers

    When is mechanical thrombectomy plus best medical management recommended for LVO-related acute ischaemic stroke patients in the 6-24 hour time window?

    <p>For patients meeting the eligibility criteria of published randomized trials</p> Signup and view all the answers

    What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What further randomized trials are needed to inform clinical decision-making regarding MT?

    <p>Mothership and drip-and-ship approaches</p> Signup and view all the answers

    What imaging is recommended for all patients suspected of having an acute stroke?

    <p>Emergency imaging of the brain, including vascular imaging</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients eligible for both IVT and MT?

    <p>IVT plus MT</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients not eligible for IVT?

    <p>MT alone</p> Signup and view all the answers

    Is there evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>No</p> Signup and view all the answers

    Which model may be favored in metropolitan areas for MT?

    <p>The mothership model</p> Signup and view all the answers

    Is there an upper age limit for MT?

    <p>No</p> Signup and view all the answers

    What patient selection criteria may be used for MT?

    <p>Age, severity or infarct core volume, and type of neurological impairment, among others</p> Signup and view all the answers

    What is the standard of care for acute ischaemic stroke patients with large vessel occlusion (LVO)?

    <p>Mechanical thrombectomy (MT)</p> Signup and view all the answers

    When is MT plus BMM recommended for LVO-related acute ischaemic stroke patients?

    <p>Within 6 hours after symptom onset</p> Signup and view all the answers

    When is MT plus BMM recommended for LVO-related acute ischaemic stroke patients in the 6-24 hour time window?

    <p>For patients meeting the eligibility criteria of published randomized trials</p> Signup and view all the answers

    What should be the basis for patient selection for MT?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    Which emergency imaging is recommended for all patients suspected of having an acute stroke?

    <p>CT scan of the brain</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients eligible for both IVT and MT?

    <p>MT plus BMM</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients not eligible for IVT?

    <p>MT plus BMM</p> Signup and view all the answers

    Is there enough evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>No</p> Signup and view all the answers

    Which model may be favored in metropolitan areas for MT?

    <p>The mothership model</p> Signup and view all the answers

    Is there an upper age limit for MT?

    <p>No</p> Signup and view all the answers

    What are some patient selection criteria for MT?

    <p>Patient's severity or infarct core volume, and type of neurological impairment</p> Signup and view all the answers

    What is the preferred treatment modality in patients with LVO-related acute ischemic stroke and associated extracranial carotid artery stenosis or occlusion?

    <p>No recommendation can be provided</p> Signup and view all the answers

    What is the standard of care for acute ischaemic stroke patients with large vessel occlusion?

    <p>Mechanical thrombectomy (MT)</p> Signup and view all the answers

    What is the recommended time window for MT plus BMM in LVO-related acute ischaemic stroke patients?

    <p>Within 6 hours after symptom onset</p> Signup and view all the answers

    What is the recommendation for patients meeting the eligibility criteria of published randomized trials in the 6-24 hour time window?

    <p>MT plus BMM</p> Signup and view all the answers

    What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What is the recommendation for patients with LVO-related ischaemic stroke eligible for both IVT and MT?

    <p>IVT plus MT</p> Signup and view all the answers

    What is the recommendation for patients with LVO-related ischaemic stroke not eligible for IVT?

    <p>MT as a standalone treatment</p> Signup and view all the answers

    Is there enough evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>No</p> Signup and view all the answers

    Which model may be favored in metropolitan areas for MT?

    <p>Mothership model</p> Signup and view all the answers

    Is there an upper age limit for MT?

    <p>No</p> Signup and view all the answers

    What is the recommended blood pressure target during and 24 hours after MT?

    <p>Below 180/105 mmHg</p> Signup and view all the answers

    What is the recommended TICI grade for reperfusion during MT?

    <p>TICI Grade 3</p> Signup and view all the answers

    What is the preferred MT modality over contact aspiration alone?

    <p>Stent retriever</p> Signup and view all the answers

    What is the recommended time window for MT plus BMM in patients with LVO-related acute ischaemic stroke?

    <p>6-24 hours</p> Signup and view all the answers

    In LVO-related ischaemic stroke patients eligible for both IVT and MT, what is the recommended treatment?

    <p>IVT plus MT</p> Signup and view all the answers

    What is the mothership model in the context of MT for acute ischaemic stroke?

    <p>Transporting patients to a comprehensive stroke center</p> Signup and view all the answers

    What is the drip-and-ship model in the context of MT for acute ischaemic stroke?

    <p>Performing MT in a local hospital</p> Signup and view all the answers

    What is the recommended blood pressure target during and after MT?

    <p>Below 180/105 mmHg</p> Signup and view all the answers

    What is the TICI Grade 3 reperfusion?

    <p>Complete reperfusion with no visible thrombus</p> Signup and view all the answers

    What is the preferred MT technique?

    <p>Stent retriever alone</p> Signup and view all the answers

    What is the recommended approach to anesthesia during MT?

    <p>Local anesthesia</p> Signup and view all the answers

    What is the recommended treatment for patients with LVO-related ischaemic stroke not eligible for IVT?

    <p>MT alone</p> Signup and view all the answers

    What is the recommended approach to systolic blood pressure drops during MT?

    <p>Systolic blood pressure drops should be avoided</p> Signup and view all the answers

    What is the recommended treatment for patients with high-grade stenosis or occlusion?

    <p>Intraprocedural stenting</p> Signup and view all the answers

    What is the recommended approach to patient selection for MT?

    <p>Multiple factors including age, severity or infarct core volume, and type of neurological impairment</p> Signup and view all the answers

    What is the standard of care for acute ischaemic stroke patients with large vessel occlusion?

    <p>Thrombectomy plus best medical management</p> Signup and view all the answers

    Within what time frame is MT plus BMM recommended for LVO-related acute ischaemic stroke patients?

    <p>Within 6 hours after symptom onset</p> Signup and view all the answers

    When is MT plus BMM in the 6-24 hour time window recommended for patients with LVO-related acute ischaemic stroke?

    <p>For patients meeting the eligibility criteria of published randomized trials</p> Signup and view all the answers

    What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What emergency imaging is recommended for all patients suspected of having an acute stroke?

    <p>Emergency imaging of the brain, including vascular imaging</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients eligible for both IVT and MT?

    <p>IVT plus MT</p> Signup and view all the answers

    What is recommended for LVO-related ischaemic stroke patients not eligible for IVT?

    <p>MT as a standalone treatment</p> Signup and view all the answers

    Is there evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>There is limited evidence</p> Signup and view all the answers

    When may the mothership model be favored over the drip-and-ship model for MT?

    <p>In metropolitan areas</p> Signup and view all the answers

    Is an upper age limit for MT justified?

    <p>No</p> Signup and view all the answers

    What patient selection criteria may be used for MT?

    <p>Age, severity or infarct core volume, and type of neurological impairment, among others</p> Signup and view all the answers

    What is the preferred method for MT?

    <p>Stent retriever</p> Signup and view all the answers

    What is the standard of care for acute ischemic stroke patients with large vessel occlusion?

    <p>MT plus BMM</p> Signup and view all the answers

    When is MT plus BMM recommended for patients in the 6-24 hour time window?

    <p>For patients meeting the eligibility criteria of published randomized trials</p> Signup and view all the answers

    What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What is the recommended emergency imaging for all patients suspected of having an acute stroke?

    <p>CT and vascular imaging</p> Signup and view all the answers

    In LVO-related ischemic stroke patients eligible for both IVT and MT, what treatment is recommended?

    <p>IVT plus MT</p> Signup and view all the answers

    What is the recommended treatment for LVO-related ischemic stroke patients not eligible for IVT?

    <p>MT alone</p> Signup and view all the answers

    Is there sufficient evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>Limited evidence</p> Signup and view all the answers

    What is the recommended model for MT in metropolitan areas?

    <p>Mothership model</p> Signup and view all the answers

    Is there an upper age limit for MT?

    <p>No</p> Signup and view all the answers

    What is the recommended blood pressure target during and 24 hours after MT?

    <p>Below 180/105 mmHg</p> Signup and view all the answers

    What is the recommended TICI grade for reperfusion during MT?

    <p>TICI Grade 3</p> Signup and view all the answers

    What is the preferred treatment modality for MT?

    <p>ADAPT followed by aspiration as rescue therapy if needed</p> Signup and view all the answers

    What is the standard of care for acute ischemic stroke patients with large vessel occlusion?

    <p>Mechanical thrombectomy plus best medical management</p> Signup and view all the answers

    When is MT plus BMM recommended for LVO-related acute ischemic stroke patients?

    <p>Within 6 hours after symptom onset</p> Signup and view all the answers

    When is MT plus BMM recommended for LVO-related acute ischemic stroke patients in the 6-24 hour time window?

    <p>For patients meeting the eligibility criteria of published randomized trials</p> Signup and view all the answers

    What should patient selection for MT be based on?

    <p>Clinical and imaging characteristics</p> Signup and view all the answers

    What emergency imaging is recommended for all patients suspected of having an acute stroke?

    <p>Imaging of the brain, including vascular imaging</p> Signup and view all the answers

    What is recommended for LVO-related ischemic stroke patients eligible for both IVT and MT?

    <p>IVT plus MT</p> Signup and view all the answers

    What is recommended for LVO-related ischemic stroke patients not eligible for IVT?

    <p>MT as a standalone treatment</p> Signup and view all the answers

    Is there evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field?

    <p>Limited evidence</p> Signup and view all the answers

    Which model may be favored in metropolitan areas for MT?

    <p>The mothership model</p> Signup and view all the answers

    What is the recommended approach for patients aged 80 years or more with LVO-related acute ischemic stroke?

    <p>MT plus BMM</p> Signup and view all the answers

    What should blood pressure be kept below during and 24 hours after MT?

    <p>180/105 mmHg</p> Signup and view all the answers

    What is the preferred treatment modality for LVO-related acute ischemic stroke and associated extracranial carotid artery stenosis or occlusion?

    <p>No recommendation can be provided</p> Signup and view all the answers

    Study Notes

    Guidelines for Mechanical Thrombectomy in Acute Ischaemic Stroke

    • Mechanical thrombectomy (MT) is the standard of care for acute ischaemic stroke patients with large vessel occlusion (LVO).

    • MT plus best medical management (BMM) is recommended within 6 hours after symptom onset for patients with LVO-related acute ischaemic stroke to improve functional outcome.

    • MT plus BMM in the 6-24 hour time window is recommended for patients meeting the eligibility criteria of published randomized trials.

    • Patient selection for MT should be based on clinical and imaging characteristics.

    • Further randomized trials are needed to inform clinical decision-making with regard to the mothership and drip-and-ship approaches, anesthesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.

    • Emergency imaging of the brain, including vascular imaging, is recommended for all patients suspected of having an acute stroke.

    • In LVO-related ischaemic stroke patients eligible for both IVT and MT, IVT plus MT is recommended over MT alone.

    • In LVO-related ischaemic stroke patients not eligible for IVT, MT as a standalone treatment is recommended.

    • There is limited evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field.

    • The mothership model may be favored in metropolitan areas, while the drip-and-ship model may be used when transportation times are longer.

    • Application of an upper age limit for MT is not justified, and patients aged 80 years or more with LVO-related acute ischaemic stroke should be treated with MT plus BMM.

    • Patient selection criteria for MT may include age, severity or infarct core volume, and type of neurological impairment, among others.Recommendations for Mechanical Thrombectomy in Acute Ischemic Stroke

    • The recommendations are based on PICO questions (Population, Intervention, Comparator, Outcome) for mechanical thrombectomy (MT) in acute ischemic stroke.

    • Patients with anterior circulation stroke and large infarct core should be included in randomized controlled trials comparing MT plus best medical management versus best medical management alone.

    • Advanced imaging is not necessary for patient selection in anterior circulation stroke presenting from 0-6 hours from the last known well time.

    • Advanced imaging can improve identification of patients who may benefit from MT and decrease the risk of symptomatic intracerebral hemorrhage.

    • MT performed in a comprehensive stroke center improves functional outcomes, reduces time to reperfusion, and reduces the rate of symptomatic intracerebral hemorrhage.

    • Interventionalists should attempt a TICI Grade 3 reperfusion if achievable with reasonable safety.

    • ADAPT may be used as standard first-line treatment, followed by aspiration alone as rescue therapy if needed. Stent retriever is preferred over contact aspiration alone for MT.

    • Local anesthesia or conscious sedation may be favored over general anesthesia in patients undergoing MT if the patient is able to undergo MT without general anesthesia.

    • Blood pressure should be kept below 180/105 mmHg during and 24 hours after MT, with a lower blood pressure target in case of complete reperfusion.

    • Systolic blood pressure drops should be avoided during MT.

    • Patients with high-grade stenosis or occlusion may be treated with intraprocedural stenting if needed and should be included in dedicated randomized controlled trials.

    • No recommendation can be provided regarding which treatment modality should be favored in patients with LVO-related acute ischemic stroke and associated extracranial carotid artery stenosis or occlusion.

    Guidelines for Mechanical Thrombectomy in Acute Ischaemic Stroke

    • Mechanical thrombectomy (MT) is the standard of care for acute ischaemic stroke patients with large vessel occlusion (LVO).

    • MT plus best medical management (BMM) is recommended within 6 hours after symptom onset for patients with LVO-related acute ischaemic stroke to improve functional outcome.

    • MT plus BMM in the 6-24 hour time window is recommended for patients meeting the eligibility criteria of published randomized trials.

    • Patient selection for MT should be based on clinical and imaging characteristics.

    • Further randomized trials are needed to inform clinical decision-making with regard to the mothership and drip-and-ship approaches, anesthesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.

    • Emergency imaging of the brain, including vascular imaging, is recommended for all patients suspected of having an acute stroke.

    • In LVO-related ischaemic stroke patients eligible for both IVT and MT, IVT plus MT is recommended over MT alone.

    • In LVO-related ischaemic stroke patients not eligible for IVT, MT as a standalone treatment is recommended.

    • There is limited evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field.

    • The mothership model may be favored in metropolitan areas, while the drip-and-ship model may be used when transportation times are longer.

    • Application of an upper age limit for MT is not justified, and patients aged 80 years or more with LVO-related acute ischaemic stroke should be treated with MT plus BMM.

    • Patient selection criteria for MT may include age, severity or infarct core volume, and type of neurological impairment, among others.Recommendations for Mechanical Thrombectomy in Acute Ischemic Stroke

    • The recommendations are based on PICO questions (Population, Intervention, Comparator, Outcome) for mechanical thrombectomy (MT) in acute ischemic stroke.

    • Patients with anterior circulation stroke and large infarct core should be included in randomized controlled trials comparing MT plus best medical management versus best medical management alone.

    • Advanced imaging is not necessary for patient selection in anterior circulation stroke presenting from 0-6 hours from the last known well time.

    • Advanced imaging can improve identification of patients who may benefit from MT and decrease the risk of symptomatic intracerebral hemorrhage.

    • MT performed in a comprehensive stroke center improves functional outcomes, reduces time to reperfusion, and reduces the rate of symptomatic intracerebral hemorrhage.

    • Interventionalists should attempt a TICI Grade 3 reperfusion if achievable with reasonable safety.

    • ADAPT may be used as standard first-line treatment, followed by aspiration alone as rescue therapy if needed. Stent retriever is preferred over contact aspiration alone for MT.

    • Local anesthesia or conscious sedation may be favored over general anesthesia in patients undergoing MT if the patient is able to undergo MT without general anesthesia.

    • Blood pressure should be kept below 180/105 mmHg during and 24 hours after MT, with a lower blood pressure target in case of complete reperfusion.

    • Systolic blood pressure drops should be avoided during MT.

    • Patients with high-grade stenosis or occlusion may be treated with intraprocedural stenting if needed and should be included in dedicated randomized controlled trials.

    • No recommendation can be provided regarding which treatment modality should be favored in patients with LVO-related acute ischemic stroke and associated extracranial carotid artery stenosis or occlusion.

    Guidelines for Mechanical Thrombectomy in Acute Ischaemic Stroke

    • Mechanical thrombectomy (MT) is the standard of care for acute ischaemic stroke patients with large vessel occlusion (LVO).

    • MT plus best medical management (BMM) is recommended within 6 hours after symptom onset for patients with LVO-related acute ischaemic stroke to improve functional outcome.

    • MT plus BMM in the 6-24 hour time window is recommended for patients meeting the eligibility criteria of published randomized trials.

    • Patient selection for MT should be based on clinical and imaging characteristics.

    • Further randomized trials are needed to inform clinical decision-making with regard to the mothership and drip-and-ship approaches, anesthesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.

    • Emergency imaging of the brain, including vascular imaging, is recommended for all patients suspected of having an acute stroke.

    • In LVO-related ischaemic stroke patients eligible for both IVT and MT, IVT plus MT is recommended over MT alone.

    • In LVO-related ischaemic stroke patients not eligible for IVT, MT as a standalone treatment is recommended.

    • There is limited evidence to use a prehospital scale for identifying potential thrombectomy candidates in the prehospital field.

    • The mothership model may be favored in metropolitan areas, while the drip-and-ship model may be used when transportation times are longer.

    • Application of an upper age limit for MT is not justified, and patients aged 80 years or more with LVO-related acute ischaemic stroke should be treated with MT plus BMM.

    • Patient selection criteria for MT may include age, severity or infarct core volume, and type of neurological impairment, among others.Recommendations for Mechanical Thrombectomy in Acute Ischemic Stroke

    • The recommendations are based on PICO questions (Population, Intervention, Comparator, Outcome) for mechanical thrombectomy (MT) in acute ischemic stroke.

    • Patients with anterior circulation stroke and large infarct core should be included in randomized controlled trials comparing MT plus best medical management versus best medical management alone.

    • Advanced imaging is not necessary for patient selection in anterior circulation stroke presenting from 0-6 hours from the last known well time.

    • Advanced imaging can improve identification of patients who may benefit from MT and decrease the risk of symptomatic intracerebral hemorrhage.

    • MT performed in a comprehensive stroke center improves functional outcomes, reduces time to reperfusion, and reduces the rate of symptomatic intracerebral hemorrhage.

    • Interventionalists should attempt a TICI Grade 3 reperfusion if achievable with reasonable safety.

    • ADAPT may be used as standard first-line treatment, followed by aspiration alone as rescue therapy if needed. Stent retriever is preferred over contact aspiration alone for MT.

    • Local anesthesia or conscious sedation may be favored over general anesthesia in patients undergoing MT if the patient is able to undergo MT without general anesthesia.

    • Blood pressure should be kept below 180/105 mmHg during and 24 hours after MT, with a lower blood pressure target in case of complete reperfusion.

    • Systolic blood pressure drops should be avoided during MT.

    • Patients with high-grade stenosis or occlusion may be treated with intraprocedural stenting if needed and should be included in dedicated randomized controlled trials.

    • No recommendation can be provided regarding which treatment modality should be favored in patients with LVO-related acute ischemic stroke and associated extracranial carotid artery stenosis or occlusion.

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    Related Documents

    European Stroke Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke 2019 PDF

    Description

    Test your knowledge on the guidelines for Mechanical Thrombectomy in Acute Ischemic Stroke with this informative quiz! Learn about the standard of care for patients with large vessel occlusion, patient selection criteria, recommended time frames, and more. Improve your understanding of the different treatment modalities and imaging techniques used in mechanical thrombectomy, and gain insights into the latest research on the topic. Whether you're a medical professional or simply interested in stroke care, this quiz will challenge and inform you.

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