What are the AHA/ASA recommendations for the emergency treatment of patients with acute ischemic stroke (AIS)?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

The 2018 American Heart Association/American Stroke Association guidelines for the emergency treatment of patients with acute ischemic stroke extend the time limit on mechanical clot removal from 6 hours to up to 24 hours in select patients. The new guidelines recommend thrombectomy in eligible patients 6 to 16 hours after a stroke. [107] They also broaden the eligibility criteria for IV tPA.

Currently, 4 devices are approved by the FDA for the endovascular treatment of acute ischemic stroke, as follows:

  • Merci Retriever (Concentric Medical, Mountain View, CA): Corkscrew-shaped device that captures and engages clots

  • Penumbra System (Penumbra, Alameda, CA): Employs both aspiration and extraction

  • Solitaire FR Revascularization Device (Covidien, Dublin, Ireland): Stent-retriever system; combines the ability to restore blood flow and retrieve clot

  • Trevo (Concentric Medical, Mountain View, CA): Stent-retriever system


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