Acute revascularization in ischemic stroke: Updated Swiss guidelines

Clinical and Translational Neuroscience

Swiss Corner

Jean-Daniel Rouvé¹  Yvan Gasche²  Henrik Gensicke³  Stefan Engelter³  Krassen Nedeltchev⁴  Georg Kägi⁵  Marcel Arnold⁶  Carlo Cereda⁷  Susanne Wegener⁸  David Bervini⁹  Tilman Schubert^1,10  Christophe Bonvin^1,11  Guido Schwegler^1,12  Pasquale Mordasini^1,13  Patrik Michel^1,14  Emmanuel Carrera^1,15  Michael Diepers^1,16  Stephan Wetzel^1,17  Thomas Nyffeler^1,18 

[1] Anesthesiology Service, Lausanne University Hospital, Lausanne, Switzerland;Department of Anesthesiology, Pharmacology, Intensive Care & Emergency Medicine, University of Geneva, Geneva, Switzerland;Department of Neurology and Stroke Centre, University Hospital Basel, Basel, Switzerland;Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland;Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland;Department of Neurology, Inselspital Bern and University of Bern, Bern, Switzerland;Department of Neurology, Neurocentro della Svizzera Italiana, Lugano Civic Hospital, Lugano, Switzerland;Department of Neurology, University Hospital Zurich, Zurich, Switzerland;Department of Neurosurgery, Inselspital Bern and University of Bern, Berne, Switzerland;Diagnostic and Interventional Neuroradiology, Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland;Division of Neurology and Stroke Unit, Hôpital du Valais, Sion, Switzerland;Division of Neurology, Hospital Limmattal, Schlieren, Switzerland;Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern and University of Bern, Berne, Switzerland;Neurology Service, Lausanne University Hospital, Lausanne, Switzerland;Neurology Service, University Hospitals of Geneva, Geneva, Switzerland;Neuroradiology Division, Cantonal Hospital Aarau, Aarau, Switzerland;Neuroradiology, Hirslanden Clinic, Zürich, Switzerland;Neurozentrum, Cantonal Hospital Lucerne, Lucerne, Switzerland;

关键词: Stroke;    revascularization;    thrombolysis;    thrombectomy;    guidelines;    Swiss;   

DOI  :  10.1177/2514183X21999228

来源: Sage Journals

【 摘 要 】

In acute ischemic stroke, intravenous thrombolysis (IVT) and acute endovascular therapy (EVT) have been shown to reduce long-term disability in randomized trials. International guidelines are partially not up to date and may not address situations for which there is limited scientific evidence. The goals of the present guidelines are to summarize the current scientific data for acute revascularization treatments to make sure that all Swiss Centers apply a similar, evidence, or consensus-based treatment standard. A multidisciplinary working group of the Swiss Stroke Society (SSS) searched and reviewed the literature on new randomized controlled trials (RCTs), large case series, meta-analyses, and other guidelines since the previous recommendations in 2009 to elaborate the consensus guidelines. The new RCTs have confirmed the effectiveness of IVT in various populations up to 4.5 h and proven the benefit of acute EVT up to approximately 8 h. For patients with unknown onset (including wake-up stroke), IVT and EVT can be effective up to 24 h after last proof of good health if patients are selected with advanced neuroimaging. Multiple case series and meta-analyses allow narrowing down the indications and relative and absolute contraindications to optimize the benefit–risk ratio of acute revascularization.

【 授权许可】

CC BY   
© The Author(s) 2021

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