37
4.7.2. Endovascular Thrombectomy for Adult Patients
COR LOE
Recommendations
rombectomy 0 to 6 Hours for Nondominant Proximal M2 Division MCA,
Distal MCA, Anterior Cerebral Artery, and Posterior Cerebral Artery Occlusions
3: No
benefit
A
8. In patients with AIS from occlusion of the proximal
nondominant or codominant division proximal M2 segment
of the MCA, or distal MCA, anterior cerebral artery (ACA),
or posterior cerebral artery (PCA), EVT is not recommended
to improve functional outcomes.
* Limited generalizability in specific subpopulations: Specific patient groups were
underrepresented or excluded in the trials supporting this recommendation. Consequently,
the applicability of these findings is limited in individuals >80 years, those with renal failure,
patients with refractory hypertension (SBP ≥185 mm Hg or DBP ≥110 mm Hg ), comorbid
psychiatric or medical illnesses that confound neurological assessments, or patients with a life
expectancy <3 months.
CT hypodensity volume as a predictor of poor outcomes: In an exploratory analysis of the
SELECT2 trial, a threshold of ≥26 mL of severe CT hypodensity, defined as the lower 99%
CI of the contralateral thalamic gray matter (≤26 Hounsfield units), was associated with
diminished treatment benefit from EVT. Patients with CT hypodensity above this threshold
derived no functional benefit and instead experienced increased risks, including cerebral
edema and the need for hemicraniectomy.
†
Limited generalizability in specific subpopulations: Specific patient groups were
underrepresented or excluded in the trials supporting this recommendation. Consequently,
the applicability of these findings is limited in individuals >80 years, those with significant
head and neck vessel tortuosity, comorbid psychiatric or medical conditions that confound
neurological assessments, seizures at stroke onset that hinder accurate NIHSS evaluations, a
strong suspicion of underlying intracranial stenosis, or a life expectancy <6 months.
4.7.3. Posterior Circulation Stroke
COR LOE
Recommendations
1 A
1. (New and of High Impact) In patients with AIS, with basilar
artery occlusion, a baseline mRS score of 0 to 1, NIHSS score
≥10 at presentation, and PC-ASPECTS ≥6 (mild ischemic
damage), EVT within 24 hours from onset of symptoms
is recommended to achieve better functional outcome and
reduce mortality.
2b B-R
2. In patients with AIS, with basilar artery occlusion, a baseline
mRS score of 0 to 1, NIHSS score 6 to 9 at presentation, and
PC-ASPECTS ≥6 (mild ischemic damage) the effectiveness
of EVT within 24 hours to improve functional outcomes and
reduce mortality is not well established.
(cont'd)
