Mechanical Thrombectomy Guidelines Quiz

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.