Guidelines for Mechanical Thrombectomy in Japan, the Fourth Edition, March 2020: A Guideline from the Japan Stroke Society, the Japan Neurosurgical Society, and the Japanese Society for Neuroendovascular Therapy

• Published in: Neurologia medico-chirurgica Vol. 61; no. 3; pp. 163 - 192
• Main Authors: YAMAGAMI, Hiroshi, HAYAKAWA, Mikito, INOUE, Manabu, IIHARA, Koji, OGASAWARA, Kuniaki, TOYODA, Kazunori, HASEGAWA, Yasuhiro, OHATA, Kenji, SHIOKAWA, Yoshiaki, NOZAKI, Kazuhiko, EZURA, Masayuki, IWAMA, Toru, JSS/JNS/JSNET Joint Guideline Authoring Committee
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2021; THE JAPAN NEUROSURGICAL SOCIETY; Japan Science and Technology Agency
• Subjects: Neurosurgery
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.nmc.st.2020-0357

[Preface from the Guidelines for Mechanical Thrombectomy in Japan, the First Edition (April 2014)] Acute cerebral artery occlusion is associated with very poor outcomes. Early recanalization of occluded arteries, however, may improve the outcome, and recanalization therapy has been attempted with a variety of approaches. The most well-known approach is intravenous therapy with the recombinant tissue-plasminogen activator (IV rt-PA), alteplase. The efficacy of IV rt-PA has been established through many randomized controlled trials (RCTs). IV rt-PA is classified as a Class I therapy in the Guidelines for the Early Management of Patients with Acute Ischemic Stroke of the American Heart Association/American Stroke Association (AHA/ASA) and a Grade A recommendation in the Japanese Guidelines for the Management of Stroke. Even as cerebrovascular medical technology has progressed, IV rt-PA remains the priority therapy for patients with acute ischemic stroke. Currently, IV rt-PA is indicated for acute ischemic stroke within 4.5 hours of onset with no contraindications.