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Standards of practice in acute ischemic stroke intervention: international recommendations
  1. Laurent Pierot1,
  2. Mahesh V Jayaraman2,
  3. Istvan Szikora3,
  4. Joshua A Hirsch4,
  5. Blaise Baxter5,
  6. Shigeru Miyachi6,
  7. Jeyaledchumy Mahadevan7,
  8. Winston Chong8,
  9. Peter J Mitchell9,
  10. Alan Coulthard10,
  11. Howard A Rowley11,
  12. Pina C Sanelli12,
  13. Donatella Tampieri13,
  14. Patrick A Brouwer14,
  15. Jens Fiehler15,
  16. Naci Kocer16,
  17. Pedro Vilela17,
  18. Alex Rovira18,
  19. Urs Fischer19,
  20. Valeria Caso20,
  21. Bart van der Worp21,
  22. Nobuyuki Sakai22,
  23. Yuji Matsumaru23,
  24. Shin-ichi Yoshimura24,
  25. Rene Anxionnat25,
  26. Hubert Desal25,
  27. Luisa Biscoito26,
  28. José Manuel Pumar27,
  29. Orlando Diaz28,
  30. Justin F Fraser29,
  31. Italo Linfante30,
  32. David S Liebeskind31,
  33. Raul G Nogueira32,
  34. Werner Hacke33,
  35. Michael Brainin34,
  36. Bernard Yan35,
  37. Mchael Soderman14,
  38. Allan Taylor36,
  39. Sirintara Pongpech37,
  40. Michihiro Tanaka38,
  41. Terbrugge Karel39
  42. Asian-Australian Federation of Interventional and Therapeutic Neuroradiology (AAFITN), Australianand New Zealand Society of Neuroradiology (ANZSNR), American Society of Neuroradiology (ASNR), Canadian Society of Neuroradiology (CSNR), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Japanese Society for NeuroEndovascular Therapy (JSNET), The French Society of Neuroradiology (SFNR) Ibero-Latin American Society of Diagnostic and Therapeutic Neuroradiology (SILAN), Society of NeuroInterventional Surgery (SNIS), Society of Vascular and Interventional Neurology (SVIN), World Stroke Organization (WSO), World Federation of Interventional Neuroradiology (WFITN)
  1. 1 Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne (URCA), Reims, France
  2. 2 Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
  3. 3 National Institute of Clinical Neurosciences, Budapest, Hungary
  4. 4 Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Erlanger Medical Center, Chattanooga, Tennessee, USA
  6. 6 Neuroendovascular Therapy Centre, Aichi Medical University, Aichi-gun, Japan
  7. 7 Pantai Hospital, Kuala Lumpur, Malaysia
  8. 8 Monash University, Clayton, Victoria, Australia
  9. 9 The University of Melbourne, The Royal Hospital of Melbourne, Parkville, Victoria, Australia
  10. 10 University of Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
  11. 11 University of Wisconsin, Madison, Wisconsin, USA
  12. 12 Northwell Health Donald and Barbara Zucker School of Medicine, New York, New York, USA
  13. 13 Queen’s University, Kingston, Ontario, Canada
  14. 14 Karolinska University Hospital, Stockholm, Sweden
  15. 15 University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
  16. 16 Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
  17. 17 Hospital Garcia de Orta, Hospital da Luz, Lisbon, Portugal
  18. 18 Hospital Univesitari Vall d’Hebron, Barcelona, Spain
  19. 19 Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
  20. 20 University of Perugia, Perugia, Italy
  21. 21 University Medical Centre, Utrecht, The Netherlands
  22. 22 Kobe City Medical Centre General Hospital, Kobe, Japan
  23. 23 University of Tsukuba, Tsukuba, Japan
  24. 24 Hyogo College of Medicine, Nishinomiya, Japan
  25. 25 CHU Nantes, Nantes, France
  26. 26 Hospital Universitário Santa Maria, Lisbon, Portugal
  27. 27 Hospital Clinico Universitário, Santiago de Compostela, Espana
  28. 28 The Methodist Hospital, Houston, Texas, USA
  29. 29 University of Kentucky, Lexington, Kentucky, USA
  30. 30 Herbert Wertheim College of Medicine, Florida International University, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA
  31. 31 UCLA, Los Angeles, California, USA
  32. 32 Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
  33. 33 University of Heidelberg, Heidelberg, Germany
  34. 34 Danube University Krems, Krems, Austria
  35. 35 Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  36. 36 Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
  37. 37 Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  38. 38 Kameda Medical Center, Kamagowa City, Chiba, Japan
  39. 39 University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Laurent Pierot, Department of Neuroradiology, University Hospital Reims, Reims, 51100; lpierot{at}

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After the five positive randomized controlled trials showing the benefit of mechanical thrombectomy (MT) in the management of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), a multisociety meeting was organized during the 16th Congress of the World Federation of Interventional and Therapeutic Neuroradiology (WFITN), October 2015, Gold Coast (Australia). This meeting was dedicated to the training of physicians performing MT, and recommendations were published thereafter in multiple scientific journals.1

The same group of scientific societies decided to organize a similar meeting during the 17th WFITN Congress, October 2017, Budapest (Hungary). This multisociety meeting was dedicated to standards of practice in acute ischemic stroke intervention (AISI), aiming for a consensus on the minimum requirements for centers providing such treatment.

In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing MT for AIS, but not for other neurovascular diseases (a level 2 center). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (a level 3 center). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The requirements for these centers are summarized in table 1.

View this table:
Table 1

General summary of capabilities of level 1, 2, and 3 centers

Due to the relatively short time elapsed since the evidence in favor of MT has been published, some organizational aspects still require scientific validation. However, considering the extremely fast growth of such activities around the world, the multisociety group considered it timely and rational to set-up recommendations and a framework for …

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