New Ischemic Stroke Guidelines Recommend Expanded Time Window for Thrombectomy

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Mechanical thrombectomy is now recommended for anterior circulation large-vessel occlusion stroke beyond 6 hours after symptom onset, according to new ischemic stroke guidelines from the American Heart Association and the American Stroke Association. The guidelines were published in Stroke and presented at the International Stroke Conference.

The procedure is now recommended for up to 24 hours after symptom onset in eligible patients, using a combination of the NIH Stroke Scale score and results from computed tomographic perfusion or diffusion-weighted MRI. The recommendations were changed based on results of the DAWN and DEFUSE 3 trials.

Another change since the groups' 2013 guideline is expanded use of alteplase for some patients with mild stroke.

The guidelines also include several new recommendations on using telemedicine and brain imaging to help guide stroke care, as well as dual antiplatelet use.