European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke.

Turc, Guillaume; Bhogal, Pervinder; Fischer, Urs; Khatri, Pooja; Lobotesis, Kyriakos; Mazighi, Mikaël; Schellinger, Peter D; Toni, Danilo; de Vries, Joost; White, Philip; Fiehler, Jens (2019). European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke. (In Press). Journal of neurointerventional surgery BMJ Publishing Group 10.1136/neurintsurg-2018-014569

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BACKGROUND Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). OBJECTIVE To assist physicians in their clinical decisions with regard toMT. METHODS These guidelines were developed based on the standard operating procedure of the European Stroke Organisation and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 15 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. RESULTS We found high-quality evidence to recommend MT plus best medical management (BMM, including intravenous thrombolysis whenever indicated) to improve functional outcome in patients with LVO-related acute ischemic stroke within 6 hours after symptom onset. We found moderate quality of evidence to recommend MT plus BMM in the 6-24h time window in patients meeting the eligibility criteria of published randomized trials. These guidelinesdetails aspects of prehospital management, patient selection based on clinical and imaging characteristics, and treatment modalities. CONCLUSIONS MT is the standard of care in patients with LVO-related acute stroke. Appropriate patient selection and timely reperfusion are crucial. Further randomized trials are needed to inform clinical decision-making with regard tothe mothership and drip-and-ship approaches, anesthaesia modalities during MT, and to determine whether MT is beneficial in patients with low stroke severity or large infarct volume.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

20 Jan 2020 15:13

Last Modified:

20 Jan 2020 15:13

Publisher DOI:

10.1136/neurintsurg-2018-014569

PubMed ID:

30808653

Uncontrolled Keywords:

standards stroke thrombectomy

BORIS DOI:

10.7892/boris.137746

URI:

https://boris.unibe.ch/id/eprint/137746

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