Table 3.
Key recommendations for mechanical thrombectomy from three prominent guidelines in the UK and Ireland, North America, and Europe
| National Clinical Guideline for Stroke (UK and Ireland) | American Heart Association (North America) | European Stroke Organisation/European Society of Minimally Invasive Neurological Therapy (Europe) | |
| Treatment within 6 hours of symptom onset | Recommends | Recommends | Recommends |
| Treatment within 6-24 hours of symptom onset | Recommends with advanced imaging in the 12-24 hour window | Recommends with advanced imaging | Recommends with advanced imaging or CT angiography collateral scores up to 12 hours |
| Bridging treatment with intravenous thrombolysis in early window | Recommends | Recommends | Recommends |
| Clinical parameters for consideration of mechanical thrombectomy | NIHSS >5 and modified Rankin score 0-2; ASPECTS >2 in 0-12 hour window and with advanced imaging in 12-24 hours | NIHSS >5 and modified Rankin score 0-1; ASPECTS >5 | ASPECTS >5 |
| Vessel occlusions than mechanical thrombectomy is recommended for | Proximal anterior circulation, basilar, and vertebral | Proximal anterior circulation and M2/M3 within 6 hours | Not mentioned |
| Use of alternatives to advanced imaging | Not mentioned | Consider using collateral status up to 12 hours | Consider using collateral status up to 12 hours |
| Treatment of peri-procedural hypertension | Not mentioned | Maintain blood pressure <185/110 mm Hg even if intravenous thrombolysis not given | Maintain blood pressure <180/105 mm Hg |
| Pre-hospital models of patient identification for large vessel occlusion | References validated tools (eg, FAST/ROSIER) | Not mentioned | Does not recommend either drip and ship or mothership model over other |
| Use of thromboaspiration or stent retriever | Recommends both can be used | Thromboaspiration is recommended as non-inferior to stent retrievers | Does not recommend thromboaspiration alone |
NIHSS=National Institutes of Health Stroke Scale; ASPECTS=Alberta stroke programme early computed tomography score; FAST=face arms speech time; ROSIER=recognition of stroke in the emergency room; CT=computed tomography.