Patient selection for mechanical thrombectomy to treat acute ischemic stroke

MT should be performed at a stroke center with appropriate neurointerventional expertise. The TLKW is judged to be the time of stroke symptom onset (if known), or the time the patient was last seen at their baseline for patients with wake-up stroke or those found down. The ASPECTS method is used to assess the extent of ischemic changes on head CT or DWI. Refer to UpToDate topics for a full discussion of MT, including calculation of ASPECTS, NIHSS, and mRS, and other clinical issues pertaining to MT.

ACA: anterior carotid artery; ASPECTS: Alberta Stroke Program Early CT Score; CT: computed tomography; CTA: computed tomography angiography; CTP: computed tomography perfusion; DSA: digital subtraction angiography; DWI: diffusion-weighted magnetic resonance imaging; ICA: internal carotid artery; LVO: large vessel (artery) occlusion; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; mRS: modified Rankin Scale; MT: mechanical thrombectomy; NIHSS: National Institutes of Health Stroke Scale; PWI: perfusion-weighted magnetic resonance imaging.

* All patients with acute ischemic stroke should be simultaneously evaluated for treatment with intravenous thrombolysis; refer to UpToDate topics for details.

¶ Urgent imaging is usually done with CT and CTA, less often with MRI and MRA.

Δ Advanced imaging is not essential but can be used at centers with CTP or DWI/PWI and automated software imaging analysis to determine infarct volume; patients can be selected for MT if they have salvageable brain tissue with a mismatch between a relatively larger area of hypoperfusion (ischemic penumbra) and a smaller area of irreversibly injured brain tissue (infarct core). Refer to UpToDate text for details.

◊ There is intracranial arterial occlusion of the distal ICA, or the M1 or proximal M2 segment of the MCA, as shown by CTA, MRA, or DSA.

§ MT may be a treatment option at expert stroke centers for patients with basilar artery LVO, but benefit is uncertain.

Graphic 141874 Version 2.0

خرید پکیج

Patient selection for mechanical thrombectomy to treat acute ischemic stroke