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508 Stroke Thrombectomy

capable of offering reperfusion therapies within ap- American Stroke Association focused update of the 2013 guidelines for
propriate timeframes. (Berglund et al 2012 [5]) the early management of patients with acute ischemic stroke regarding
endovascular treatment: a guideline for healthcare professionals from the
Ambulance services should preferentially transfer American Heart Association/American Stroke Association. Stroke 2015;46:
suspected stroke patients to a hospital capable of 3020–35.
delivering reperfusion therapies as well as stroke unit 8. European-Stroke-Organization. Consensus statement on mechanical
care. (O’Brien et al 2012 [13] thrombectomy in acute ischemic stroke—ESO-Karolinska stroke update
2014 in collaboration with ESMINT and ESNR. 2015.
TIA 9. Casaubon LK, Boulanger JM, Blacquiere D, et al. Canadian stroke best
practice recommendations: hyperacute stroke care guidelines, update
Patients with symptoms that are present or fluctuat- 2015. Int J Stroke 2015;10:924–40.
ing at time of initial assessment should be treated as
having stroke and be immediately referred for emer-
gency department and stroke specialist assessment,
investigation and reperfusion therapy where appro-
priate. (Lavallee et al 2007
All patients with suspected transient ischaemic at-
tack (TIA i.e. focal neurological symptoms due to
focal ischaemia that have fully resolved) should be
assessed urgently. (Lavallee et al 2007 [19]

All TIA patients with anterior circulation symptoms
should undergo urgent carotid imaging with CT angi-
ography (aortic arch to cerebral vertex), carotid Dop-
pler ultrasound or MR angiography. Carotid imaging
should preferably be done during the initial assess-
ment but should not be delayed more than 2 working
days

Vascular imaging
All patients who would potentially be candidates for
endovascular thrombectomy should have vascular
imaging from aortic arch to cerebral vertex (CTA or
MRA) to establish the presence of vascular occlusion
as a target for thrombectomy and to assess proximal
vascular access. (Goyal et al 2016 [53

REFERENCES
1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy
for large vessel ischaemic stroke: a meta-analysis of individual patient data
from five randomised trials. Lancet Published Online First: 18 Feb 2016.
doi: 10.1016/S0140-6736(16)00163-X.
2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraar-
terial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.
3. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy
for ischemic stroke with perfusion-imaging selection. N Engl J Med
2015;372:1009–18.
4. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid
endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–
30.
5. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after in-
travenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95.
6. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after
symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306.
7. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/

GCDC 2017