What are the AHA and ASA treatment guidelines for ischemic stroke?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Updated guidelines from the American Heart Association (AHA) and the American Stroke Association (ASA) extend the time limit on mechanical clot removal from 6 hours to up to 24 hours in select patients. [107]  The new guidelines recommend thrombectomy in eligible patients 6 to 16 hours after a stroke. [144, 145] They also broaden the eligibility criteria by allowing patients who are ineligible for IV tPA to undergo mechanical thrombectomy within 6 hours.

Patients should be considered for thrombectomy in under 6 hours after stroke onset if they have a large clot in one of the large vessels at the base of the brain and meet the following criteria:

  •  Prestroke modified Rankin Scale (mRS) score of 0 to 1;

  •  Causative occlusion of the internal carotid artery or middle cerebral artery segment 1 (M1);

  •  Age over 18 years;

  •  National Institutes of Health Stroke Scale score of 6 or greater; and

  •  Alberta Stroke Program Early CT Score of 6 or greater.

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