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European Stroke Organisation (ESO)- European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke
  1. Guillaume Turc1,2,3,4,
  2. Pervinder Bhogal5,
  3. Urs Fischer6,
  4. Pooja Khatri7,
  5. Kyriakos Lobotesis8,
  6. Mikaël Mazighi3,9,10,11,
  7. Peter D Schellinger12,
  8. Danilo Toni13,
  9. Joost de Vries14,
  10. Philip White15,
  11. Jens Fiehler16
  1. 1 Neurology Department, Sainte-Anne Hospital, Paris, France
  2. 2 Université Paris Descartes, Paris, France
  3. 3 DHU NeuroVasc, Paris, France
  4. 4 INSERM U1266, Paris, France
  5. 5 The Royal London Hospital, London, UK
  6. 6 Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
  7. 7 Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
  8. 8 Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
  9. 9 INSERM U1148, Sorbonne Paris Cité Université Paris Diderot, Paris, France
  10. 10 Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
  11. 11 Stroke Unit Lariboisière Hospital, Paris, France
  12. 12 Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Bochum, Germany
  13. 13 Hospital Policlinico Umberto I, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
  14. 14 Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
  15. 15 Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle Upon Tyne, UK
  16. 16 Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Guillaume Turc, Neurology Department, Sainte-Anne Hospital, Paris, France; g.turc{at}ghu-paris.fr

Abstract

Background Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO). The aim of this guideline document is to assist physicians in their clinical decisions with regard to MT.

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 6–24 hour time window in patients meeting the eligibility criteria of published randomized trials. These guidelines further detail 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 to the 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.

  • standards
  • stroke
  • thrombectomy
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Table 1

Synoptic table of PICO questions, evidence based recommendations, and expert opinions

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Footnotes

  • Endorsed by Stroke Alliance for Europe (SAFE)

  • Contributors All contributed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests Intellectual and financial disclosures of working group members are presented in Supplemental table I

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Presented at This article is co-published in the European Stroke Journal, February 2019.

  • Patient consent for publication Not required.

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