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General Supportive Early Management
4.7.4. Endovascular Techniques
COR LOE
Recommendations
rombectomy General Techniques
1 A
1. In patients with AIS due to an LVO, EVT with stent
retrievers, contact aspiration, or combination techniques is
recommended to achieve rapid and adequate reperfusion.
1 A
2. In patients with AIS undergoing EVT, reperfusion to an
extended TICI grade 2b/2c/3 is recommended as early as
possible within the therapeutic window to achieve maximum
functional benefit at 90 days.
1 B-R
3. In patients with AIS undergoing EVT, either general
anesthesia or procedural sedation are recommended to
facilitate EVT.
2b B-R
4. In patients with AIS undergoing EVT, the use of a proximal
balloon to guide catheters to achieve improved outcomes
remains uncertain.
3: No
benefit
A
5. In patients with AIS from occlusion of medium or distal
vessels of the anterior, middle (nondominant or codominant
M2, M3), or posterior cerebral arteries, EVT with stent
retrievers is of no benefit for improving functional outcomes.
rombectomy Adjunctive Techniques
2b B-NR
6. In patients with AIS undergoing EVT in the setting of
tandem extracranial-intracranial anterior circulation
occlusions, acute treatment of both, including emergent
extracranial stenting, may be reasonable to achieve higher
good functional outcome.
2b B-NR
7. In patients with AIS in the setting of failed EVT, the use of
rescue intracranial balloon angioplasty and/or stenting to
improve functional outcome remains uncertain.
2b B-R
8. In patients with AIS who achieve complete or near-complete
EVT (modified TICI 2b or greater), the administration
of adjunctive intraarterial thrombolytics with urokinase,
alteplase, or tenecteplase may be reasonable to improve
cerebral reperfusion and 90-day functional outcome.
3: No
benefit
B-R
9. (New and of High Impact) In the management of patients
with AIS in the setting of LVO, preoperative administration
of tirofiban before EVT is not useful to improve 90-day
functional outcome.
