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AHA/ASA 2018 AIS guidelines: impact and opportunity for endovascular stroke care
  1. Thabele Leslie-Mazwi1,
  2. Ronil V Chandra2,
  3. Justin F Fraser3,
  4. Brian Hoh4,
  5. Blaise W Baxter5,
  6. Felipe C Albuquerque6,
  7. Joshua A Hirsch7
  1. 1 Departments of Neurosurgery and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Department of Radiology, Monash University, Melbourne, Victoria, Australia
  3. 3 Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
  4. 4 Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  5. 5 Tennessee Interventional & Imaging Associates/Erlanger, Chattanooga, Tennessee, USA
  6. 6 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  7. 7 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Thabele Leslie-Mazwi, Departments of Neurosurgery and Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; tleslie-mazwi{at}mgh.harvard.edu

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Introduction

At the International Stroke Conference (ISC) in Los Angeles in January 2018, the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke were released by the American Heart Association/American Stroke Association (AHA/ASA).1 These guidelines replaced the previous 2013 guidelines and their subsequent updates.2 3 They became an immediate focal point of discussion, with a range of questions raised. One example was the robust discussion regarding how these Guidelines should address patient selection for thrombectomy between 6 and 24 hours given differences in inclusion criteria for DAWN and DEFUSE 3.4 5 How should the new evidence be interpreted and incorporated into routine clinical practice?

To understand these new guidelines, it is necessary to remember their function and helpful to review the process involved in creating them. Their purpose is to provide clinicians a comprehensive, evidence-based summary of treatment recommendations. They inform a broad audience involved in the early management of adults with acute ischemic stroke: pre-hospital providers, physicians, allied health professionals, and hospital administrators. The creation of this document required a broad-based writing group with multidisciplinary backgrounds, appointed by the AHA/ASA Stroke Council’s Scientific Statements Oversight Committee. The writing group reviewed the stroke literature and drafted recommendations with supporting evidence. For limited clinical questions, an independent evidence review committee performed systematic reviews, the results of which were incorporated. The full writing group then evaluated the complete guidelines, which had to be unanimously approved. The draft guideline was then reviewed by four expert peer reviewers, members of the Stroke Council’s Scientific Statements Oversight and Leadership Committees. It was approved by the American Heart Association Science Advisory and Coordinating and Executive Committees. Prior to publication, it was reviewed for evidence-based integrity and endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons, as well as …

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