Neurointervention.  2019 Sep;14(2):71-81. 10.5469/neuroint.2019.00164.

2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

• Ko SB
• Park HK
• Kim BM
• Heo JH
• Rha JH
• Kwon SU
• Kim JS
• Lee BC
• Suh SH
• Jung C
• Jeong HW
• Kang DH
• Bae HJ
• Yoon BW
• Hong KS

• KMID: 2458486
• DOI: http://doi.org/10.5469/neuroint.2019.00164

Abstract

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch, defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thoroughly reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient.

Keyword

Guideline; Cerebral infarction; Large cerebral artery occlusion; Reperfusion; Mechanical thrombolysis

MeSH Terms

Arteries
Caregivers
Cerebral Infarction
Consensus
Health Personnel
Humans
Korea
Mechanical Thrombolysis
Reperfusion
Standard of Care
Stroke*
Writing

Reference

1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 372:11–20.

2. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372:1009–1018.

3. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372:2285–2295.

4. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372:2296–2306.

5. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372:1019–1030.

6. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387:1723–1731.

7. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015; 46:3020–3035.

8. Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C, et al. Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke. 2016; 11:134–147.

9. Casaubon LK, Boulanger JM, Blacquiere D, Boucher S, Brown K, Goddard T, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015; 10:924–940.

10. Hong KS, Ko SB, Lee JS, Yu KH, Rha JH. Endovascular recanalization therapy in acute ischemic stroke: updated meta-analysis of randomized controlled trials. J Stroke. 2015; 17:268–281.

11. Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016; 316:1279–1288.

12. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012; 11:860–887.

13. Lansberg MG, Christensen S, Kemp S, Mlynash M, Mishra N, Federau C, et al. Computed tomographic perfusion to predict response to recanalization in ischemic stroke. Ann Neurol. 2017; 81:849–856.

14. Jovin TG, Liebeskind DS, Gupta R, Rymer M, Rai A, Zaidat OO, et al. Imaging-based endovascular therapy for acute ischemic stroke due to proximal intracranial anterior circulation occlusion treated beyond 8 hours from time last seen well: retrospective multicenter analysis of 237 consecutive patients. Stroke. 2011; 42:2206–2211.

15. Copen WA, Rezai Gharai L, Barak ER, Schwamm LH, Wu O, Kamalian S, et al. Existence of the diffusion-perfusion mismatch within 24 hours after onset of acute stroke:dependence on proximal arterial occlusion. Radiology. 2009; 250:878–886.

16. Jovin TG, Saver JL, Ribo M, Pereira V, Furlan A, Bonafe A, et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods. Int J Stroke. 2017; 12:641–652.

17. Albers GW, Lansberg MG, Kemp S, Tsai JP, Lavori P, Christensen S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3). Int J Stroke. 2017; 12:896–905.

18. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018; 378:11–21.

19. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018; 378:708–718.

20. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49:e46. –e110.

21. Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018; 13:949–984.

22. Australian Clinical Guidelines for Stroke Management. Chapter 8.2 neurointervention. Australian Clinical Guidelines for Stroke Management. Chapter 8.2 neurointervention. https://app.Magicapp.Org/app#/guideline/2638/section/32356. 2017. Accessed March 15, 2019.

23. United States Department of Health and Human Services. Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville, MD: AHCPR;1993. 107.

24. Kudo K, Christensen S, Sasaki M, Østergaard L, Shirato H, Ogasawara K, et al. Accuracy and reliability assessment of CT and MR perfusion analysis software using a digital phantom. Radiology. 2013; 267:201–211.

25. Austein F, Riedel C, Kerby T, Meyne J, Binder A, Lindner T, et al. Comparison of perfusion CT software to predict the final infarct volume after thrombectomy. Stroke. 2016; 47:2311–2317.

26. Kudo K, Sasaki M, Yamada K, Momoshima S, Utsunomiya H, Shirato H, et al. Differences in CT perfusion maps generated by different commercial software: quantitative analysis by using identical source data of acute stroke patients. Radiology. 2010; 254:200–209.

27. Warach SJ, Luby M, Albers GW, Bammer R, Bivard A, Campbell BC, et al. Acute stroke imaging research roadmap III imaging selection and outcomes in acute stroke reperfusion clinical trials: consensus recommendations and further research priorities. Stroke. 2016; 47:1389–1398.

28. Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986; 2:53–63.

29. Wardlaw JM, Seymour J, Cairns J, Keir S, Lewis S, Sandercock P. Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. Stroke. 2004; 35:2477–2483.

30. Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004; 292:1823–1830.

31. Brazzelli M, Sandercock PA, Chappell FM, Celani MG, Righetti E, Arestis N, et al. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev. 2009; 4:CD007424.

32. Jadhav AP, Desai SM, Kenmuir CL, Rocha M, Starr MT, Molyneaux BJ, et al. Eligibility for endovascular trial enrollment in the 6- to 24-hour time window: analysis of a single comprehensive stroke center. Stroke. 2018; 49:1015–1017.

33. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and clinical research center for stroke. J Stroke. 2013; 15:2–20.

34. Lee KJ, Kim BJ, Kim DE, Ryu WS, Han MK, Kim JT, et al. Nationwide estimation of eligibility for endovascular thrombectomy based on the DAWN trial. J Stroke. 2018; 20:277–279.