Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery

Gandhi, Chirag D.; Al‐Mufti, Fawaz; Singh, Inder Paul; Abruzzo, Todd; Albani, Barbara; Ansari, Sameer A.; Arthur, Adam S; Bain, Mark; Baxter, Blaise; Bulsara, Ketan R.; Caplan, Justin M.; Chen, Michael; Dabus, Guilherme; Frei, Don; Hetts, Steven W.; Hussain, Muhammad Shazam; Jayaraman, Mahesh; Kayan, Yasha; Klucznik, Richard P.; Lee, Seon Kyu; Mack, William J.; Leslie‐Mazwi, Thabele M; McTaggart, Ryan; Meyers, Philip M.; Mokin, Maxim; Patsalides, Athos; Prestigiacomo, Charles J.; Pride, G. Lee; Starke, Robert M.; Sunenshine, Peter; Fraser, Justin F.

doi:10.1136/neurintsurg-2017-013554

Cited by 33 publications

(23 citation statements)

References 74 publications

(22 reference statements)

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“…Thus, comprehensive stroke centers will face an increasing number of patients, and the healthcare system must adapt in the coming years in order to manage these increased needs. Since the DAWN and DEFUSE3 trials used patients with LVO, future studies including patients with smaller-scale strokes should be tested with the new window of 6–24 h [80, 81]. …”

Section: Resultsmentioning

confidence: 99%

Mandatory Neuroendovascular Evolution: Meeting the New Demands

et al. 2018

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Background: Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary: Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages: The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.

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Section: Resultsmentioning

confidence: 99%

Mandatory Neuroendovascular Evolution: Meeting the New Demands

et al. 2018

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“…We recommend that providers use currently available guidelines and recommendations based on multiple randomized trials for identification and management of large vessel occlusion whenever possible. [6][7][8] Because of the significant proven benefit of thrombectomy for patients with emergent large vessel occlusion, denial of this treatment likely creates a greater drain on healthcare resources.…”

Section: Criteria For Mechanical Thrombectomymentioning

confidence: 99%

Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19

Fraser

Arthur

Chen

et al. 2020

J NeuroIntervent Surg

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128

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“…Therefore, the opportunity exists to emphasize the importance of anesthesia protocols, attention to choice of anesthetic agents, and blood pressure control. SNIS Guidelines make recommendations about these options 19. However, if conscious sedation is equivalent, continuing to prioritize this for stroke treatment seems reasonable.…”

Section: Independent Evidence Review Committeementioning

confidence: 99%

“…The SNIS Guideline avoids delineation of a specific device, taking instead the perspective that recanalization rather than the method of achieving it is what the trials have demonstrated to be effective 19. A variety of new thrombectomy devices are jostling for space in stroke treatment, including the 3D (Penumbra, Alameda, California) and Embotrap (Neuravi, Galway, Ireland).…”

Section: Independent Evidence Review Committeementioning

confidence: 99%