Guillaume Turc1,2,3,4, Pervinder Bhogal5, Urs Fischer6, Pooja Khatri7, Kyriakos Lobotesis8, Mikaël Mazighi3,9,10,11, Peter D Schellinger12, Danilo Toni13, Joost de Vries14, Philip White15, Jens Fiehler16. 1. Neurology Department, Sainte-Anne Hospital, Paris, France. 2. Université Paris Descartes, Paris, France. 3. DHU NeuroVasc, Paris, France. 4. INSERM U1266, Paris, France. 5. The Royal London Hospital, London, UK. 6. Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Switzerland. 7. Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA. 8. Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK. 9. INSERM U1148, Sorbonne Paris Cité Université Paris Diderot, Paris, France. 10. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France. 11. Stroke Unit Lariboisière Hospital, Paris, France. 12. Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University hospitals of the Ruhr-University of Bochum, Germany. 13. Hospital Policlinico Umberto I, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy. 14. Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands. 15. Institute of Neuroscience (Stroke Research Group), Newcastle, University, Newcastle Upon Tyne, UK. 16. Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: Mechanical thrombectomy (MT) has become the cornerstone of acute ischaemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT. METHODS: These Guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. RESULTS: We found high quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischaemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24h time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. CONCLUSIONS: MT is the standard of care in patients with LVO-related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision making with regard to the mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.
BACKGROUND: Mechanical thrombectomy (MT) has become the cornerstone of acute ischaemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT. METHODS: These Guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. RESULTS: We found high quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischaemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24h time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. CONCLUSIONS: MT is the standard of care in patients with LVO-related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision making with regard to the mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.
Authors: Bruce C V Campbell; Peter J Mitchell; Leonid Churilov; Nawaf Yassi; Timothy J Kleinig; Richard J Dowling; Bernard Yan; Steven J Bush; Vincent Thijs; Rebecca Scroop; Marion Simpson; Mark Brooks; Hamed Asadi; Teddy Y Wu; Darshan G Shah; Tissa Wijeratne; Henry Zhao; Fana Alemseged; Felix Ng; Peter Bailey; Henry Rice; Laetitia de Villiers; Helen M Dewey; Philip M C Choi; Helen Brown; Kendal Redmond; David Leggett; John N Fink; Wayne Collecutt; Thomas Kraemer; Martin Krause; Dennis Cordato; Deborah Field; Henry Ma; Bill O'Brien; Benjamin Clissold; Ferdinand Miteff; Anna Clissold; Geoffrey C Cloud; Leslie E Bolitho; Luke Bonavia; Arup Bhattacharya; Alistair Wright; Abul Mamun; Fintan O'Rourke; John Worthington; Andrew A Wong; Christopher R Levi; Christopher F Bladin; Gagan Sharma; Patricia M Desmond; Mark W Parsons; Geoffrey A Donnan; Stephen M Davis Journal: JAMA Date: 2020-04-07 Impact factor: 56.272
Authors: Guillaume Turc; Georgios Tsivgoulis; Heinrich J Audebert; Hieronymus Boogaarts; Pervinder Bhogal; Gian Marco De Marchis; Ana Catarina Fonseca; Pooja Khatri; Mikaël Mazighi; Natalia Pérez de la Ossa; Peter D Schellinger; Daniel Strbian; Danilo Toni; Philip White; William Whiteley; Andrea Zini; Wim van Zwam; Jens Fiehler Journal: Eur Stroke J Date: 2022-02-17
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: S Nannoni; F Ricciardi; D Strambo; G Sirimarco; M Wintermark; V Dunet; P Michel Journal: AJNR Am J Neuroradiol Date: 2021-01-28 Impact factor: 3.825
Authors: Orhun Utku Aydin; Abdel Aziz Taha; Adam Hilbert; Ahmed A Khalil; Ivana Galinovic; Jochen B Fiebach; Dietmar Frey; Vince Istvan Madai Journal: BMC Med Imaging Date: 2021-07-16 Impact factor: 1.930