Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion

• Published in: Neurological research and practice Vol. 5; no. 1; p. 19
• Main Authors: Bösel, Julian, Hubert, Gordian J, Jesser, Jessica, Möhlenbruch, Markus A, Ringleb, Peter A
• Format: Journal Article
• Language: English
• Published: England Springer Nature B.V 18.05.2023; BioMed Central; BMC
• Subjects: Acute ischemic stroke; Cardiovascular system; Cerebral blood flow; Clinical trials; Emergency medical care; Endovascular stroke treatment; Intravenous thrombolysis; Ischemia; Large vessel occlusion; Neurology; Patients; Severe stroke; Standard Operating Procedure; Stroke; Stroke thrombectomy; Thrombolysis; Endovascular stroke treatment; Stroke thrombectomy; Acute ischemic stroke; Intravenous thrombolysis; Severe stroke; Large vessel occlusion
• ISSN: 2524-3489; 2524-3489
• DOI: 10.1186/s42466-023-00245-9

Groundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the optimal version or combination of best medical and interventional therapy to the selected patient, yielding favorable or even excellent clinical outcomes within time windows unheard of before. The provision of the best possible individual therapy has become a guideline-based gold standard, but remains a great challenge. With geographic, regional, cultural, economic and resource differences worldwide, optimal local solutions have to be strived for. This standard operation procedure (SOP) is aimed to give a suggestion of how to give patients access to and apply modern recanalizing therapy for acute ischemic stroke caused by LVO. The SOP was developed based on current guidelines, the evidence from the most recent trials and the experience of authors who have been involved in the above-named development at different levels. This SOP is meant to be a comprehensive, yet not too detailed template to allow for freedom in local adaption. It comprises all relevant stages in providing care to the patient with severe ischemic stroke such as suspicion and alarm, prehospital acute measures, recognition and grading, transport, emergency room workup, selective cerebral imaging, differential treatment by recanalizing therapies (intravenous thrombolysis, endovascular stroke treatmet, or combined), complications, stroke unit and neurocritical care. The challenge of giving patients access to and applying recanalizing therapies in severe ischemic stroke may be facilitated by a systematic, SOP-based approach adapted to local settings.