2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

Abstract

Endovascularrecanalizationtherapy(ERT) has been a standard of care forpatientswithacuteischemicstrokedue to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated itsclinicalbenefit. Recently, two randomizedclinicaltrials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome ofpatientswho had a target mismatch, defined as eitherclinical-core mismatch or perfusion-core mismatch, which prompted theupdateof nationalguidelinesin several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT inpatientswithacuteLAO in Korea, theClinicalPracticeGuidelinesCommittee of theKoreanStrokeSociety decided to revise the previousKoreanClinicalPracticeGuidelinesofStrokefor ERT. For thisupdate, the members of the writing group were appointed by theKoreanStrokeSociety and theKoreanSociety of Interventional Neuroradiology. After thoroughly reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The currentguidelinesare intended to help healthcare providers,patients, and their caregivers make well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient.