Endovascular Therapy in Patients With Acute Ischemic Stroke With Large Infarct: A Guideline From the Society of Vascular and Interventional Neurology

Authors

• Maxim Mokin
• Tudor G Jovin
• Sunil A Sheth
• Thanh N Nguyen
• Kaiz S Asif
• Ameer E Hassan
• Ashutosh P Jadhav
• Cynthia Kenmuir
• David S Liebeskind
• Ossama Mansour
• Raul G Nogueira
• Robin Novakovic
• Santiago Ortega-Gutierrez
• Albert J Yoo
• Waldo R Guerrero
• Amer M Malik

Language

English

Publication Date

3-1-2025

Journal

STROKE: Vascular and Interventional Neurology

DOI

10.1161/SVIN.124.001581

PMID

41573174

PMCID

PMC12671639

PubMedCentral® Posted Date

2-27-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Recent randomized clinical trials of endovascular therapy in patients with large infarct provided new evidence in support of endovascular interventions in patients with acute ischemic stroke. The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee aims to provide up-to-date recommendations on focused relevant clinical questions. Here, we review current evidence and provide recommendations for the selection and endovascular treatment of patients with anterior circulation large vessel occlusion and large infarct.

Methods: The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee assembled a writing group and recruited interdisciplinary experts to review and evaluate the current literature. Recommendations were assigned using the Guidelines and Practice Standards Class of Recommendation/Level of Evidence algorithm and guideline format. The recommendations were developed through a consensus process involving an expert panel of vascular neurologists, neurointensivists, and neurointerventionalists. The final guideline was approved by the Guidelines and Practice Standards committee and the Society of Vascular and Interventional Neurology board of directors.

Results: Literature review yielded 6 high-quality randomized trials and 6 meta-analyses of patients with large infarct from anterior circulation large vessel occlusion treated with endovascular therapy versus medical management that have been extracted to derive the enclosed summary recommendations. We provide separate recommendations for those presenting within 6 hours of symptoms onset and those presenting in the 6-24-hour treatment window.

Conclusion: These guidelines provide focused practical recommendations based on recent evidence regarding the selection and endovascular therapy in patients with acute ischemic stroke with large infarct.

Keywords

guideline, large infarct, large vessel occlusion, stroke, thrombectomy

Published Open-Access

yes

Recommended Citation

Mokin, Maxim; Jovin, Tudor G; Sheth, Sunil A; et al., "Endovascular Therapy in Patients With Acute Ischemic Stroke With Large Infarct: A Guideline From the Society of Vascular and Interventional Neurology" (2025). Faculty, Staff and Student Publications. 3835.
https://digitalcommons.library.tmc.edu/uthmed_docs/3835