Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment

Purpose—The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. Methods—This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council’s Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/ American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

[1]  Gregory W Albers,et al.  Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial , 2012, The Lancet.

[2]  Max Wintermark,et al.  Multiparametric MRI and CT Models of Infarct Core and Favorable Penumbral Imaging Patterns in Acute Ischemic Stroke , 2013, Stroke.

[3]  M. Golomb,et al.  Intra-arterial Tissue Plasminogen Activator for Thrombosis Complicating Cerebral Angiography in a 17-Year-Old Girl , 2003, Journal of child neurology.

[4]  Rafael A. Vega,et al.  Mechanical thrombectomy for pediatric stroke arising from an atrial myxoma: case report. , 2015, Journal of neurosurgery. Pediatrics.

[5]  P. Sandercock,et al.  International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion , 2005, The Lancet.

[6]  Z. H. Anastasian Anaesthetic management of the patient with acute ischaemic stroke. , 2014, British journal of anaesthesia.

[7]  E. Deshaies Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy , 2013, Journal of Clinical Neuroscience.

[8]  Jamie L Banks,et al.  Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis , 2007, Stroke.

[9]  J. Rankin Cerebral Vascular Accidents in Patients over the Age of 60: II. Prognosis , 1957, Scottish medical journal.

[10]  R. Nogueira,et al.  Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries , 2013, Journal of NeuroInterventional Surgery.

[11]  A. Demchuk,et al.  Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. , 2001, AJNR. American journal of neuroradiology.

[12]  F. Sallustio,et al.  Thrombectomy within 8 hours after symptom onset in ischemic stroke , 2015 .

[13]  G. deVeber Stroke: Delays in the timely diagnosis of stroke in children , 2010, Nature Reviews Neurology.

[14]  K. Uchino,et al.  Initial Experience Using the 5MAX™ ACE Reperfusion Catheter in Intra-arterial Therapy for Acute Ischemic Stroke , 2014, Journal of cerebrovascular and endovascular neurosurgery.

[15]  R. Bammer,et al.  Real‐time diffusion‐perfusion mismatch analysis in acute stroke , 2010, Journal of magnetic resonance imaging : JMRI.

[16]  Max Wintermark,et al.  A trial of imaging selection and endovascular treatment for ischemic stroke. , 2013, The New England journal of medicine.

[17]  Joanna M. Wardlaw,et al.  Recommendations on Angiographic Revascularization Grading Standards for Acute Ischemic Stroke: A Consensus Statement , 2013, Stroke.

[18]  A. Shaikhouni,et al.  The Clinical and Radiographic Importance of Distinguishing Partial from Near-Complete Reperfusion Following Intra-Arterial Stroke Therapy , 2013, American Journal of Neuroradiology.

[19]  M. Krause,et al.  Endovascular therapy for ischemic stroke with perfusion-imaging selection. , 2015, The New England journal of medicine.

[20]  N. Venketasubramanian,et al.  Timing of recanalization after intravenous thrombolysis and functional outcomes after acute ischemic stroke. , 2013, JAMA neurology.

[21]  M. Wintermark,et al.  Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2013, Stroke.

[22]  D. Kallmes,et al.  Conscious Sedation versus General Anesthesia during Endovascular Acute Ischemic Stroke Treatment: A Systematic Review and Meta-Analysis , 2015, American Journal of Neuroradiology.

[23]  Joseph P. Broderick,et al.  Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. , 1995 .

[24]  J. Broadhead,et al.  WHO consensus statement. , 1990, The British journal of psychiatry : the journal of mental science.

[25]  Michael D Hill,et al.  Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. , 2013, The New England journal of medicine.

[26]  L. Beenen,et al.  Carotid pseudo-occlusion on CTA in patients with acute ischemic stroke: A concerning observation , 2013, Clinical Neurology and Neurosurgery.

[27]  Gregory W Albers,et al.  Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials , 2010, The Lancet.

[28]  A. Demchuk,et al.  Thrombectomy within 8 hours after symptom onset in ischemic stroke. , 2015, The New England journal of medicine.

[29]  Eric E. Smith,et al.  Randomized assessment of rapid endovascular treatment of ischemic stroke. , 2015, The New England journal of medicine.

[30]  N. Engl A randomized trial of intraarterial treatment for acute ischemic stroke , 2015 .

[31]  J. Marler,et al.  Measurements of acute cerebral infarction: a clinical examination scale. , 1989, Stroke.

[32]  Michela Ponzio,et al.  Endovascular treatment for acute ischemic stroke. , 2013, The New England journal of medicine.

[33]  Elad I Levy,et al.  Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial , 2012, The Lancet.

[34]  D. Heck,et al.  Carotid stenting and intracranial thrombectomy for treatment of acute stroke due to tandem occlusions with aggressive antiplatelet therapy may be associated with a high incidence of intracranial hemorrhage , 2014, Journal of NeuroInterventional Surgery.

[35]  Scott Hamilton,et al.  Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials , 2004, The Lancet.

[36]  A. Meretoja,et al.  Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis , 2015, International journal of stroke : official journal of the International Stroke Society.

[37]  H. Diener,et al.  Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. , 2015, The New England journal of medicine.

[38]  A. Rai,et al.  Balloon Guide Catheter Improves Revascularization and Clinical Outcomes With the Solitaire Device: Analysis of the North American Solitaire Acute Stroke Registry , 2014, Stroke.

[39]  S. Tjoumakaris,et al.  Endovascular stroke intervention in the very young , 2014, Clinical Neurology and Neurosurgery.

[40]  C. Zimmer,et al.  Endovascular Treatment of Acute Intracerebral Artery Occlusions with the Solitaire Stent: Single-Centre Experience with 108 Recanalization Procedures , 2012, Cerebrovascular Diseases.

[41]  J. Mocco,et al.  Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke , 2014, Journal of NeuroInterventional Surgery.

[42]  P. Sandercock,et al.  Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials | NOVA. The University of Newcastle's Digital Repository , 2014 .