15
3.2. Initial, Vascular, and Multimodal Imaging Approaches
(cont'd)
COR LOE
Recommendations
Endovascular rombectomy Evaluation
1 A
8. In patients with suspected AIS and LVO presenting within
24 hours of last known well, emergent brain and vascular
imaging (CT/CTA or MRI/MRA) of the cervical and
intracranial vessels should be performed as rapidly as possible
for EVT selection and treatment planning.
2a A
9. In patients with suspected AIS and LVO presenting within
6 to 24 hours of last known well, adjunctive CTP, MRI
(DWI-FLAIR mismatch), or MR DWI-PWI with automated
postprocessing software analysis can be useful in the
evaluation for EVT, if immediately available.
2b B-R
10. In patients with suspected AIS and LVO based on prehospital
assessment with a validated stroke severity scale (eg, RACE
>4) and eligible for EVT, direct triage to the angiography
suite (DTAS) for flat-panel head CT versus conventional
imaging workflow followed by catheter-based angiography
may be considered to reduce time to intervention and
improve functional outcomes.
2b B-NR
11. In emergently transferred patients with suspected AIS due to
LVO (based on imaging or clinical assessment) and eligible
for EVT, DTAS may be considered without repeat brain
imaging (unless there is clinical change or transfer delay) on
arrival to the thrombectomy center.
