医学
指南
神经学
观察研究
随机对照试验
冲程(发动机)
神经组阅片室
闭塞
急诊分诊台
临床试验
临床实习
医学物理学
放射科
物理疗法
急诊医学
外科
内科学
病理
精神科
工程类
机械工程
作者
Thanh N. Nguyen,Alicia C. Castonguay,James E. Siegler,Simon Nagel,Maarten G Lansberg,Adam de Havenon,Sunil A Sheth,Mohamad Abdalkader,Jenny P Tsai,Gregory W. Albers,Hesham Masoud,Tudor G Jovin,Sheila Martins,Raul G Nogueira,Osama O. Zaidat
出处
期刊:Stroke: vascular and interventional neurology
[Wiley]
日期:2023-01-01
卷期号:3 (1)
被引量:10
标识
DOI:10.1161/svin.122.000512
摘要
Background Recent clinical trials investigating endovascular therapy in the extended time window have opened new treatment paradigms for patients with late‐presenting large vessel occlusion stroke. The aim of this guideline is to provide up‐to‐date recommendations for the diagnosis, selection, and medical or endovascular treatment of patients with large vessel occlusion presenting in the extended time window. 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 by the writing group using the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Class of Recommendation/Level of Evidence algorithm and Society of Vascular and Interventional Neurology Guidelines and Practice Standards guideline format. The final guideline was approved by all members of the writing group, the Guidelines and Practice Standards committee, and the Society of Vascular and Interventional Neurology board of directors. Results Literature review yielded 3 high‐quality randomized trials and several observational studies that have been extracted to derive the enclosed summary recommendations. In patients with large vessel occlusion presenting in the 6‐ to 24‐hour window and with clinical–imaging mismatch as defined by the DAWN (Diffusion‐Weighted Imaging or Computed Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake‐Up and Late Presenting Strokes Undergoing Neurointervention With Trevo) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) studies, endovascular therapy is recommended. Noncontrast computed tomography can be used to evaluate infarct size as the sole imaging modality for patient selection, particularly when access to computed tomography perfusion or magnetic resonance imaging is limited or if their performance would incur substantial delay to treatment. In addition, several clinical questions were reviewed based on the available evidence and consensus grading. Conclusions These guidelines provide practical recommendations based on recent evidence on the diagnosis, selection, and treatment of patients with large vessel occlusion stroke presenting in the extended time window.
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