J Korean Neurol Assoc.  2020 May;38(2):77-87. 10.17340/jkna.2020.2.1.

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

Affiliations
  • 1Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 3Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Neurology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
  • 6Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 7Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 8Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 9Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 10Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
  • 11Department of Neurosurgery and Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
  • 12Department of Neurosurgery and Radiology, Kyungpook National University Hospital, Daegu, Korea
  • 13Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

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 the five landmark ERT trials up to 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window 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 thorough 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 their 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

Practice guideline; Cerebral infarction; Cerebral artery diseases; Carotid artery thrombosis; Reperfusion
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