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Endovascular Therapy in Patients With Acute Ischemic Stroke With Large Infarct: A Guideline From the Society of Vascular and Interventional Neurology
Journal article   Open access   Peer reviewed

Endovascular Therapy in Patients With Acute Ischemic Stroke With Large Infarct: A Guideline From the Society of Vascular and Interventional Neurology

Maxim Mokin, Tudor Jovin, Sunil Sheth, Thanh Nguyen, Kaiz Asif, Ameer Hassan, Ashutosh Jadhav, Cynthia Kenmuir, David Liebeskind, Ossama Mansour, …
Stroke: vascular and interventional neurology, Vol.5(2), e001581
03/01/2025
DOI: 10.1161/SVIN.124.001581
PMCID: PMC12671639
PMID: 41573174
url
https://doi.org/10.1161/SVIN.124.001581View
Published (Version of record) Open Access

Abstract

BackgroundRecent randomized clinical trials of endovascular therapy in patients with large infarct provided new evidence in support of endovascular interventions in patients with acute ischemic stroke. The Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee aims to provide up‐to‐date recommendations on focused relevant clinical questions. Here, we review current evidence and provide recommendations for the selection and endovascular treatment of patients with anterior circulation large vessel occlusion and large infarct.MethodsThe Society of Vascular and Interventional Neurology Guidelines and Practice Standards committee assembled a writing group and recruited interdisciplinary experts to review and evaluate the current literature. Recommendations were assigned using the Guidelines and Practice Standards Class of Recommendation/Level of Evidence algorithm and guideline format. The recommendations were developed through a consensus process involving an expert panel of vascular neurologists, neurointensivists, and neurointerventionalists. The final guideline was approved by the Guidelines and Practice Standards committee and the Society of Vascular and Interventional Neurology board of directors.ResultsLiterature review yielded 6 high‐quality randomized trials and 6 meta‐analyses of patients with large infarct from anterior circulation large vessel occlusion treated with endovascular therapy versus medical management that have been extracted to derive the enclosed summary recommendations. We provide separate recommendations for those presenting within 6 hours of symptoms onset and those presenting in the 6–24‐hour treatment window.ConclusionThese guidelines provide focused practical recommendations based on recent evidence regarding the selection and endovascular therapy in patients with acute ischemic stroke with large infarct.
Ischemia Neurology Stroke guideline large infarct large vessel occlusion stroke thrombectomy

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