Thrombectomy for people with acute ischaemic stroke

1.4.5Offer thrombectomy as soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis (if not contraindicated and within the licensed time window), to people who have:

acute ischaemic stroke and

confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

taking into account the factors in recommendation 1.4.8 (see additional information). [2019]

1.4.6Offer thrombectomy as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake?up strokes):

who have acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA and

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

taking into account the factors in recommendation 1.4.8 (see additional information). [2019]

1.4.7Consider thrombectomy together with intravenous thrombolysis (where not contraindicated and within the licensed time window) as soon as possible for people last known to be well up to 24 hours previously (including wake?up strokes):

who have acute ischaemic stroke and confirmed occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA and

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

taking into account the factors in recommendation 1.4.8 (see additional information). [2019]

1.4.8Take into account the person’s overall clinical status and the extent of established infarction on initial brain imaging to inform decisions about thrombectomy. Select people who have (in addition to the factors in recommendations 1.4.5 to 1.4.7):

a pre-stroke functional status of less than 3 on the modified Rankin scale and

a score of more than 5 on the National Institutes of Health Stroke Scale (NIHSS). [2019]

G Mohan. Current British Guidelines