Ischemic stroke
ICD-10 I63 · ICD-11 8B11

Treatment of Acute Ischemic Stroke from Anterior Circulation Proximal Large Vessel Occlusion (ICA or M1)

This protocol defines the evidence-based approach to acute ischemic stroke caused by proximal large vessel occlusion in the anterior circulation — the internal carotid artery (ICA) or M1 segment of the middle cerebral artery — presenting within 24 hours of symptom onset in patients with significant neurological deficit and preserved brain tissue on imaging.

Clinical scenario
Treatment approach (partial overview)

Management centres on a catheter-based endovascular intervention targeting mechanical reperfusion of the occluded vessel. The procedure is performed as rapidly as possible after imaging confirms eligibility, within defined time windows — either within 6 hours, or between 6 and 24 hours when appropriate imaging criteria are met.

Specific technique, device selection, anaesthetic management, and the full imaging-based selection criteria are detailed in the complete structured regimen.

Clinical goal

The primary angiographic target is reperfusion to an extended TICI grade 2b/2c/3, achieved as early as possible within the therapeutic window to maximise functional benefit at 90 days.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/STR.0000000000000513

  1. In patients with AIS from anterior circulation proximal LVO of the ICA or M1, presenting within 6 hours from onset of symptoms, with NIHSS score ≥6, prestroke mRS score of 0 to 1, and ASPECTS 3 to 10, EVT is recommended to improve functional clinical outcomes and reduce mortality.
  2. In patients with AIS from anterior circulation proximal LVO of the ICA or M1 presenting between 6 and 24 hours from onset of symptoms, with NIHSS score ≥6, prestroke mRS score 0 to 1 and ASPECTS ≥6, EVT is recommended to improve functional clinical outcomes and reduce mortality.
  3. In patients with AIS due to an LVO, EVT with stent retrievers, contact aspiration, or combination techniques is recommended to achieve rapid and adequate reperfusion.
  4. In patients with AIS undergoing EVT, reperfusion to an extended TICI grade 2b/2c/3 is recommended as early as possible within the therapeutic window to achieve maximum functional benefit at 90 days.
  5. In patients with AIS undergoing EVT, either general anesthesia or procedural sedation are recommended to facilitate EVT.
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