Turc Guillaume, Bhogal Pervinder, Fischer Urs, Khatri Pooja, Lobotesis Kyriakos, Mazighi Mikaël, Schellinger Peter D, Toni Danilo, de Vries Joost, White Philip, Fiehler Jens
Department of Neurology, Sainte-Anne Hospital, Paris, France.
Université Paris Descartes, Paris, France.
J Neurointerv Surg. 2023 Aug;15(8):e8. doi: 10.1136/neurintsurg-2018-014569. Epub 2019 Feb 26.
Mechanical thrombectomy (MT) has become the cornerstone of acute ischemic stroke management in patients with large vessel occlusion (LVO).
To assist physicians in their clinical decisions with regard toMT.
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.
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.
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.
机械取栓术（MT）已成为大血管闭塞（LVO）患者急性缺血性卒中治疗的基石。
协助医生进行有关机械取栓术的临床决策。
这些指南是根据欧洲卒中组织的标准操作程序制定的，并遵循了推荐分级、评估、制定和评价（GRADE）方法。一个跨学科工作组确定了15个相关问题，对文献进行了系统评价和荟萃分析，评估了现有证据的质量，并撰写了基于证据的推荐意见。如果没有足够的证据根据GRADE方法提供推荐意见，则提供专家意见。
我们发现高质量证据支持推荐机械取栓术联合最佳药物治疗（BMM，包括在有指征时进行静脉溶栓），以改善症状发作后6小时内LVO相关急性缺血性卒中患者的功能结局。我们发现中等质量证据支持在符合已发表随机试验纳入标准的患者中，在6-24小时时间窗内推荐机械取栓术联合最佳药物治疗。这些指南详细介绍了院前管理、基于临床和影像学特征的患者选择以及治疗方式等方面。
机械取栓术是LVO相关急性卒中患者的治疗标准。恰当的患者选择和及时再灌注至关重要。需要进一步的随机试验，为有关母舰式和点滴转运式方法、机械取栓术中的麻醉方式等临床决策提供依据，并确定机械取栓术对卒中严重程度低或梗死体积大的患者是否有益。
