JAMA Clinical Guidelines Synopsis July 18, 2019
Management of Patients With Acute Ischemic Stroke
James R. Brorson, Adam S. Cifu
JAMA. Published online July 18, 2019. doi:10.1001/jama.2019.10436
Guideline title
2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke
Release date
January 24, 2018
Prior version
2013
Developer
American Heart Association (AHA)/American Stroke Association (ASA)
Funding source
AHA/ASA
Target population
Adult patients with acute arterial ischemic stroke
Major recommendations
- Regional systems of stroke care should be developed that include health care facilities providing initial emergency care and those capable of endovascular stroke treatment, to which rapid transport can be arranged when appropriate (high-quality evidence; strong recommendation).
- Intravenous alteplase is recommended for patients meeting detailed eligibility requirements within 3 hours of ischemic stroke onset (high-quality evidence; strong recommendation) and between 3 and 4.5 hours of ischemic stroke onset (moderate-quality evidence; strong recommendation).
- Mechanical thrombectomy with a stent retriever is recommended for patients with a causative occlusion of the internal carotid artery or proximal middle cerebral artery with at least moderately severe presenting stroke deficits (National Institutes of Health Stroke Scale [NIHSS] score ≥6) and absence of evidence of widespread established infarction on brain imaging, when endovascular treatment can be initiated within 6 hours of symptom onset (high-quality evidence; strong recommendation).
- Mechanical thrombectomy with a stent retriever is also recommended for certain acute ischemic stroke (AIS) patients presenting at later times (moderate- to high-quality evidence; strong recommendation).
