2015 AHA/ASA Focused Update Guidelines for Acute Ischemic Stroke Regarding Endovascular Treatment

2015 AHA/ASA Focused Update Guidelines for Acute Ischemic Stroke Regarding Endovascular Treatment from Sun YaiCheng

2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment

Stroke. 2015;46:3020-3035.

• Patients should receive endovascular therapy with a stent retriever if they meet all the following criteria (Class I). (New recommendation):

1. pre-stroke Modified Rankin Scale score 0 to 1
2. acute ischemic stroke receiving IV r-tPA within 4.5 hours of onset according to guidelines from professional medical societies
3. causative occlusion of the ICA or proximal MCA
4. age ≥18 years
5. NIHSS score ≥6
6. Alberta Stroke Program Early CT score (ASPECTS) ≥6
7. treatment can be initiated (groin puncture) within 6 hours of symptom onset

• Observing patients after IV r-tPA to assess for clinical response before pursuing endovascular therapy is not required to achieve beneficial outcomes and is not recommended. (Class III). (New recommendation)

• If endovascular therapy is contemplated, a non-invasive intracranial vascular study is strongly recommended during the initial imaging evaluation of the acute stroke patient but should not delay IV r-tPA if indicated. For patients who qualify for IV r-tPA according to guidelines from professional medical societies, initiating IV rtPA before non-invasive vascular imaging is recommended for patients who have not had non-invasive vascular imaging as part of their initial imaging assessment for stroke. Non-invasive intracranial vascular imaging should then be obtained as quickly as possible (Class I). (New recommendation)

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【摘要】

• 病患若符合 endovascular therapy 條件，打完 IV tPA 後無需觀察對治療的反應，應盡快安排 endovascular therapy. (Class III)
• 若考慮做 endovascular therapy，強烈建議 CTA or MRA 腦血管評估。但 CTA or MRA 不應延誤 IV tPA 的治療。打完 IV tPA 後，即應盡快安排 CTA or MRA。 (Class I)