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AHA/ASA: Guidelines Support Endovascular Tx in Stroke

Experts say systems of care should be organized to facilitate delivery of this therapy

TUESDAY, June 30, 2015 (HealthDay News) -- Endovascular treatment should be used to treat certain stroke victims, according to new guidelines issued by the American Heart Association and American Stroke Association. The guidelines were published online June 29 in Stroke.

The focused update on endovascular treatment of acute ischemic stroke analyzes results from eight randomized clinical trials of endovascular treatment and other relevant data published since 2013, while taking into account the previous evidence summarized in the 2013 guidelines.

The guidelines specifically recommend using a stent retrieval device for patients who: (1) have a prestroke modified Rankin scale score of 0 to 1; (2) received tissue plasminogen activator (tPA) within 4.5 hours of their stroke onset, and are able to start the procedure within six hours after stroke symptoms started; (3) are at least 18 years old, as clinical trials have not been conducted with children; (4) have NIHSS score of ≥6 and ASPECTS of ≥6; and (5) have causative occlusion of the internal carotid artery or proximal middle cerebral artery.

Clinical trials have shown that the risk of intracerebral hemorrhage for patients who received tPA and then went through mechanical thrombectomy is no greater than for people who just receive anticoagulant medication, lead author William Powers, M.D., of the updated AHA guidelines and chair of neurology at the University of North Carolina at Chapel Hill, told HealthDay. "The outcomes were uniformly positive in all of the trials," he said. "It's really, really good evidence."

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