. 2015 Dec 11;2(2):131–140. doi: 10.1093/ehjcvp/pvv053

Table 2.

Indications for acute stroke interventions with and without bridging thrombolysis

	Facilitated intervention (bridging thrombolysis)^a	Direct intervention (thrombolysis not used)
Moderate or severe stroke	NIHSS ≥6	NIHSS ≥6
Stroke onset—treatment delay^b	0–4.5 h	0–6 h (6–12 h in selected patients with significant penumbra)
Contraindications for the use of thrombolytics	Bridging thrombolysis not possible	Remains the only option for reperfusion
Native CT (ASPECTS score)	≥6	≥6
Angiographic finding (CT-A, MR-A, or invasive angiography)^c	ICA, MCA-M1, BA, or VA occlusion	ICA, MCA-M1, BA, or VA occlusion

NIHSS, National Institutes of Health Stroke Score; CT-A, computed tomography angiogram; MR-A, magnetic resonance angiogram; ICA = internal carotid artery; MCA-M1, M1 segment of the middle cerebral artery; BA, basilar artery; VA, vertebral artery.

^aWhen i.v. t-PA is used, patient should proceed immediately to interventional lab (waiting for the effect of thrombolysis is not anymore acceptable in 2015!).

^bStart of CT scan—groin puncture time (including e.v. thrombolysis) should be <60 min in 90% of patients!

^cWhen native CT scan shows the hyperdense MCA sign, no angiography is necessary, patient should proceed directly to the interventional lab.