AISIntervention

Posted On February 17, 2020

Mechanical thrombectomy

• mRS = Modified Rakin Scale.
• ASPECTS = Alberta Stroke Program Early Computed Tomography Score

• Do not delay TPA if indicated.
• Occlusion of internal carotid artery or M1 segment
• Age 18 or over

• Acute stroke onset < 6 hours
  • Prestroke mRS score <2
    • (meaning no significant disability despite symptoms, able to carry out all usual duties and activities before stroke)
  • NIHSS >= 6
  • ASPECTS score >= 6
    • (meaning no large area of early ischemic changes)
• Acute stroke onset 6-24 hours
• Only for ICA/MCA occlusion, needs CTP to screen for salvageable penumbra using one of the following criterias:
  • DAWN Criteria: (used clinical imaging mismatch in patients presenting 6-24h)
    • Pre-stroke mRS < 2
    • Anticipated life expectancy > 6 months
    • NIHSS >= 10
    • < 1/3 MCA core infarction
    • Clinical imaging mismatch:
      • < 80-year: Core < 30 with NIHSS >= 10 or Core 30-50 with NIHSS >= 20
      • > 80-year: Core < 20 with NIHSS >= 10
    • Excluded: cervical ICA occlusion, PCA/ACA occlusion, dissection, tortious vessels.
  • DEFUSE 3 Criteria: (used perfusion-core mismatch in patients presenting 6-16h)
    • Age < 90
    • Imaging mismatch: If Core < 70 ml and mismatch ratio > 1.8 with at least 15 ml of viable penumbra.
    • No pre-existing terminal or debilitating illness

Animation of mechanical thrombectomy