SNIS Stroke Guideline 2015 New term ELVO Emergent

SNIS Stroke Guideline 2015 • New term: ELVO • Emergent Large Vessel Occlusion • http: //jnis. bmj. com/content/early/2015/03/12/neurintsurg 2015 -011717 • 3 Summary Statements – IV Fibrinolysis – IA Fibrinolysis – Anterior cerebral stroke + ELVO≤ 6 hr Embolectomy Jayaraman MV. J Neuro. Intervent Surg 7: 316 -21, 2015

Intravenous Fibrinolysis • IV fibrinolysis ≤ 3 hour (AHA Class I, LOE A) • IV fibrinolysis 3 – 4. 5 hour (AHA Class I, LOE B) • IV fibrinolysis even if planned IA therapy Jayaraman MV. J Neuro. Intervent Surg 7: 316 -21, 2015

IA Fibrinolysis IA fibrinolysis is reasonable in stroke with M 1 occlusion when direct catheter access for embolectomy is precluded and treatment can be completed within 6 hours of symptom onset (AHA Class IIb, LOE B) Jayaraman MV. J Neuro. Intervent Surg 7: 316 -21, 2015

Endovascular Embolectomy • For patients with anterior circulation stroke and ELVO affecting ICA or M 1 with corresponding clinical deficit(s), the addition of endovascular embolectomy results in superior clinical outcomes compared with best medical therapy alone. – Embolectomy must be performed as rapidly as possible for greatest clinical benefit – Best performed within 6 hours of stroke onset • AHA Class I, LOE A Jayaraman MV. J Neuro. Intervent Surg 7: 316 -21, 2015