Mechanical Thrombectomy in the Late Presentation of Anterior Circulation Large Vessel Occlusion Stroke: A Guideline From the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee

Authors

Thanh N Nguyen
Alicia C Castonguay
James E Siegler
Simon Nagel
Maarten G Lansberg
Adam de Havenon
Sunil A Sheth
Mohamad Abdalkader
Jenny Tsai
Gregory W Albers
Hesham E Masoud
Tudor G Jovin
Sheila O Martins
Raul G Nogueira
Osama O Zaidat
SVIN GAPS Committee

Publication Date

1-1-2023

Journal

Stroke: Vascular and Interventional Neurology

Abstract

Background and purpose: Recent clinical trials investigating endovascular therapy (EVT) in the extended time window have opened new treatment paradigms for late-presenting patients with large vessel occlusion (LVO) stroke. The aim of this guideline is to provide up to date recommendations for the diagnosis, selection, and medical or endovascular treatment of patients with LVO presenting in the extended time window.

Methods: The Society of Vascular & Interventional Neurology (SVIN) Guidelines and Practice Clinical Standards (GAPS) committee assembled a writing group and recruited interdisciplinary experts to review and evaluate the current literature. Recommendations were assigned by the writing group using the SVIN-GAPS Class of Recommendation/Level of Evidence algorithm and SVIN GAPS guideline format. The final guideline was approved by all members of the writing group, the GAPS committee, and the SVIN board of directors.

Results: Literature review yielded three high quality randomized trials and several observational studies that have been extracted to derive the enclosed summary recommendations. In patients with LVO presenting in the 6-to-24-hour window, and with clinical imaging mismatch as defined by the DAWN and DEFUSE 3 studies, EVT is recommended. Non contrast CT can be used to evaluate infarct size as sole imaging modality for patient selection, particularly when access to CT perfusion or MRI is limited, or if their performance would incur substantial delay to treatment. In addition, several clinical questions were reviewed based on the available evidence and consensus grading.

Conclusion: These guidelines provide practical recommendations based on recent evidence on the diagnosis, selection, and treatment of patients with LVO stroke presenting in the extended time window.

Keywords

SVIN Scientific Statements, Large Vessel Occlusion, Stroke, Extended Window, Late Window, Disease management, Stroke

DOI

10.1161/SVIN.122.000512

PMID

39380893

PMCID

PMC11460660

PubMedCentral® Posted Date

10-8-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes