Endovascular Therapy in Patients With Acute Ischemic Stroke With Large Infarct: A Guideline From the Society of Vascular and Interventional Neurology
Maxim Mokin, Tudor G. Jovin, Sunil G. Sheth, Thanh N. Nguyen, Kaiz Asif, Ameer E Hassan, Ashutosh P. Jadhav, Cynthia L. Kenmuir, David S. Liebeskind, Ossama Mansour, Raul G. Nogueira, Robin Novakovic, Santiago Ortega‐Gutiérrez, Albert J. Yoo, Waldo R. Guerrero, Amer Malik
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.