European Stroke Organisation (ESO)- European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke
Guillaume Turc,Pervinder Bhogal,Urs Fischer,Pooja Khatri,Kyriakos Lobotesis,Mikael Mazighi,Peter D. Schellinger,Danilo Toni,Joost de Vries,Philip White,Jens Fiehler +10 more
TLDR
High quality evidence is found to recommend Mechanical thrombectomy plus best medical management (BMM) to improve functional outcome in patients with LVO related acute ischemic stroke within 6 hours after symptom onset.Abstract:
Background Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). Objective To assist physicians in their clinical decisions with regard toMT. 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 ischemic 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 guidelinesdetails 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 tothe 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.read more
Citations
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Journal ArticleDOI
Functional Outcome Following Stroke Thrombectomy in Clinical Practice
Frank A. Wollenweber,Steffen Tiedt,Anna Alegiani,Burkhard Alber,Christopher Bangard,Jörg Berrouschot,Felix J. Bode,Tobias Boeckh-Behrens,Georg Bohner,Albrecht Bormann,Michael Braun,Franziska Dorn,Bernd Eckert,Fabian Flottmann,Gerhard F. Hamann,Karl-Heinz Henn,Moriz Herzberg,Andreas Kastrup,Lars Kellert,Christoffer Kraemer,Lars Udo Krause,Manuel Lehm,Jan Liman,Stephan Lowens,Anastasios Mpotsaris,Panagiotis Papanagiotou,Martina Petersen,Gabor C. Petzold,Gabor C. Petzold,Waltraud Pfeilschifter,Marios-Nikos Psychogios,Arno Reich,Regina von Rennenberg,Joachim Röther,Jan-Hendrik Schäfer,Eberhard Siebert,Andreas Siedow,Laszlo Solymosi,Sven Thonke,Marlies Wagner,Silke Wunderlich,Sarah Zweynert,Christian H. Nolte,Christian Gerloff,Götz Thomalla,Martin Dichgans,Martin Dichgans,Jens Fiehler +47 more
TL;DR: Mortality appears to be greater in the daily routine than otherwise reported by authors of large randomized trials and high rates of favorable outcome can be achieved on a countrywide scale by endovascular treatment.
Journal ArticleDOI
Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging.
Mayank Goyal,Johanna M. Ospel,Johanna M. Ospel,Bijoy K Menon,Mohammed A. Almekhlafi,Mahesh V Jayaraman,Jens Fiehler,Marios Psychogios,René Chapot,Aad van der Lugt,Jianmin Liu,Pengfei Yang,Ronit Agid,Werner Hacke,Melanie Walker,Urs Fischer,Negar Asdaghi,Ryan A McTaggart,Padma Srivastava,Raul G Nogueira,Jacques Moret,Jeffrey L. Saver,Michael D. Hill,Diederik W.J. Dippel,Marc Fisher +24 more
TL;DR: This review will address the uncertainty in terminology and proposes a direction towards more clarity in endovascular treatment-eligibility, and needs empirical data that clarify the definitions further and prove its value.
Journal ArticleDOI
Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA): a systematic review and individual patient data meta-analysis.
Tudor G Jovin,Tudor G Jovin,Raul G Nogueira,Raul G Nogueira,Maarten G Lansberg,Andrew M. Demchuk,Sheila Cristina Ouriques Martins,J Mocco,Marc Ribó,Ashutosh P Jadhav,Santiago Ortega-Gutierrez,Michael D. Hill,Fabricio O Lima,Diogo C Haussen,Diogo C Haussen,Scott C. Brown,Mayank Goyal,Adnan H. Siddiqui,Adnan H. Siddiqui,Jeremy J Heit,Bijoy K Menon,Stephanie Kemp,Ron Budzik,Xabier Urra,Michael P. Marks,Vincent Costalat,David S Liebeskind,Gregory W. Albers +27 more
TL;DR: In this paper, a systematic review and individual patient data meta-analysis between Jan 1, 2010, and March 1, 2021, of randomised controlled trials of endovascular stroke therapy was conducted.
Journal ArticleDOI
Blood Pressure Thresholds and Neurologic Outcomes After Endovascular Therapy for Acute Ischemic Stroke: An Analysis of Individual Patient Data From 3 Randomized Clinical Trials.
Mads Rasmussen,Silvia Schönenberger,Pia Löwhagen Hendén,Jan Brink Valentin,Ulrick S Espelund,Leif Sørensen,Niels Juul,Lorenz Uhlmann,Søren Paaske Johnsen,Alexandros Rentzos,Julian Bösel,Claus Z Simonsen +11 more
TL;DR: Critical arterial blood pressure thresholds and durations for poor outcome were found to be MABP less than 70 mm Hg for more than 10 minutes and MABp greater than 90mm Hgfor more than 45 minutes, both durations with a number needed to harm of 10 patients.
Journal ArticleDOI
Tenecteplase Thrombolysis for Acute Ischemic Stroke.
TL;DR: Meta-analyses of published stroke clinical trials of tenecteplase point to tenectEplase superiority in recanalization of large vessel occlusions and noninferiority in disability-free 3-month outcome, without increases in symptomatic intracranial hemorrhage or mortality.
References
More filters
Journal ArticleDOI
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
Julian P T Higgins,Douglas G. Altman,Peter C Gøtzsche,Peter Jüni,David Moher,Andrew D Oxman,Jelena Savović,Kenneth F. Schulz,Laura Weeks,Jonathan A C Sterne +9 more
TL;DR: The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate.
Journal ArticleDOI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
Journal ArticleDOI
A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
Debbie Beumer,Debbie Beumer,Julie Staals,Jeannette Hofmeijer,Jelis Boiten,J. De Vries,Omid S. Eshghi,Koos Keizer,R. van den Berg,A. van der Lugt,Abstr Act +10 more
TL;DR: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe.
Journal ArticleDOI
Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
Mayank Goyal,Bijoy K Menon,Wim H. van Zwam,Diederik W.J. Dippel,Peter Mitchell,Andrew M. Demchuk,Antoni Dávalos,Charles B. L. M. Majoie,Aad van der Lugt,Maria Angeles De Miquel,Geoffrey A. Donnan,Yvo B.W.E.M. Roos,Alain Bonafe,Reza Jahan,Hans-Christoph Diener,Lucie A. van den Berg,Elad I. Levy,Olvert A. Berkhemer,Vitor Mendes Pereira,Jeremy L. Rempel,Mónica Millán,Stephen M. Davis,Daniel Roy,John Thornton,Luis San Roman,Marc Ribo,Debbie Beumer,Bruce Stouch,Scott Brown,Bruce C.V. Campbell,Robert J. van Oostenbrugge,Jeffrey L. Saver,Michael D. Hill,Tudor G Jovin +33 more
TL;DR: Endovascular thrombectomy is of benefit to most patients with acute ischaemic stroke caused by occlusion of the proximal anterior circulation, irrespective of patient characteristics or geographical location, and will have global implications on structuring systems of care to provide timely treatment.
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