3
6. EVT has been established as a standard treatment for patients
with AIS with large vessel occlusion (LVO) based on numerous
randomized controlled trials. Recent evidence supports expanding
EVT to populations previously considered ineligible. Specifically,
several studies indicate that EVT benefits some patients with larger
ischemic core strokes as determined by diagnostic imaging.
7. Based on several trials showing improvement in functional
outcomes compared with medical management alone, the
guidelines also provide a strong recommendation for EVT in
patients with basilar artery occlusion presenting within 24 hours of
symptom onset and NIHSS score ≥10.
8. For the first time, the guidelines include recommendations for
interventional treatment in pediatric patients with AIS. Although
much work remains to adapt prehospital and hospital stroke
protocols for pediatric patients, expert consensus and recent studies
highlight the importance of early stroke recognition in children
and support the safety and potential benefit of endovascular
interventions in select pediatric patients with AIS. These
recommendations serve as a foundation for future recommendations
and address the phases of pediatric acute stroke care.
9. Glycemic management in patients with AIS has been updated since
the prior guidelines such that intensive glucose control to the
range of 80 to 130 mg/dL is not recommended to improve clinical
outcome and increases the risk of severe hypoglycemia.
10. Several new trials have assessed the efficacy and safety of blood
pressure (BP) lowering after IVT and EVT in adult patients,
providing new evidence that more intensive BP reduction does not
improve functional outcome after IVT and may result in harm after
EVT. Therefore, intensive systolic BP lowering to <140 mm Hg is
not recommended even in the setting of complete reperfusion (eg,
Thrombolysis In Cerebral Infarction grade 3 flow).
