🧠 Ischemic Stroke Endovascular Thrombectomy Indication
UseAssess endovascular thrombectomy indication in acute ischemic stroke.
SourceChinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
- Who it is for
- Adults with suspected acute stroke when quantifying deficit and deciding reperfusion, or TIA when judging short-term risk.
- Who it is not for
- Do not use ABCD² to decide thrombolysis. No new stroke scale.
- Formula and variables
- NIHSS is the neurologic deficit; items stay as on this page. FAST-ED is a prehospital large-vessel screen. ABCD² is age, blood pressure, clinical features, duration, and diabetes, for TIA.
- Result → next step
- This scene links only to the three tools below: deficit and time window open the thrombolysis page. A positive large-vessel screen opens thrombectomy. Drugs after the acute phase open secondary prevention. Thrombolysis shows no number until weight, onset time, pregnancy, and recent anticoagulation are known. Anticoagulant-related intracranial bleeding goes to reversal and ICH management.No numeric dose until age, weight, renal function, and pregnancy are all known. Pregnancy is contraindication or caution only.IV thrombolysis →Secondary prevention →
- Guideline
- China acute ischemic stroke guideline 2023
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Without a confirmed large-vessel occlusion on CTA/MRA, thrombectomy is not indicated — manage as routine stroke including thrombolysis assessment.
When to use
Assess endovascular thrombectomy indication in acute ischemic stroke.
How it works
Requires imaging-confirmed intracranial LVO. Anterior circulation: ≤ 6 h with mRS 0–1, NIHSS ≥ 6, ASPECTS ≥ 6 → recommended (no perfusion needed); 6–16 h needs DAWN/DEFUSE-3 mismatch; 16–24 h needs DAWN. Posterior (basilar) within 24 h may be considered after selection. > 24 h: insufficient evidence. Before thrombectomy in patients not given IV thrombolysis, BP ≤185/110 mmHg is reasonable (Class 2a, B-NR; 2026 AHA/ASA §4.3, recommendation 6).
Key points
- Without a confirmed large-vessel occlusion on CTA/MRA, thrombectomy is not indicated — manage as routine stroke including thrombolysis assessment.
- ≤ 6 h anterior circulation may proceed without perfusion imaging; 6–24 h requires CTP or DWI/PWI selection per DAWN/DEFUSE-3.
- Patients meeting IV thrombolysis criteria should be thrombolysed first, but bridge to thrombectomy without waiting for the drug's effect.
- Decisions also depend on the individual and the centre's capability; reperfuse as early as possible.
References
- [Guideline / primary source]Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Occluded circulation | Anterior (ICA/MCA M1) |
|---|---|
| Imaging-confirmed intracranial large-vessel occlusion | Yes |
| Onset (or last-known-well) to expected puncture time | 6–16h |
| NIHSS score | 12 |
| ASPECTS score | 8 |
| Pre-stroke mRS | 0–1 |
| Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) | Meets |
→Thrombectomy recommendationThrombectomy recommended
- Window/circulation：6–16h · anterior
- Assessment：6–16h anterior large-vessel occlusion meeting DAWN or DEFUSE-3 criteria — thrombectomy recommended.
- Bridging thrombolysis：Patients meeting IV alteplase/tenecteplase criteria should be thrombolysed first, but bridge to thrombectomy without waiting for its effect
| Occluded circulation | Posterior (basilar artery, etc.) |
|---|---|
| Imaging-confirmed intracranial large-vessel occlusion | No/unconfirmed |
| Onset (or last-known-well) to expected puncture time | > 24h |
| NIHSS score | 12 |
| ASPECTS score | 8 |
| Pre-stroke mRS | > 1 |
| Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) | Does not meet/not assessed |
→Thrombectomy recommendationInsufficient evidence for thrombectomy
- Note：Mechanical thrombectomy mainly targets imaging-confirmed intracranial large-vessel occlusion; without a confirmed LVO, generally do not perform thrombectomy and manage as routine ischemic stroke (including IV thrombolysis assessment)
- Basis：Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Ischemic Stroke Endovascular Thrombectomy Indication?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Ischemic Stroke Endovascular Thrombectomy Indication upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Ischemic Stroke Endovascular Thrombectomy Indication calculated in practice? Can you show a worked example?
- Inputs: Occluded circulation Anterior (ICA/MCA M1), Imaging-confirmed intracranial large-vessel occlusion Yes, Onset (or last-known-well) to expected puncture time 6–16h, NIHSS score 12, ASPECTS score 8, Pre-stroke mRS 0–1, Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) Meets → Result: Thrombectomy recommendation Thrombectomy recommended（Window/circulation: 6–16h · anterior, Assessment: 6–16h anterior large-vessel occlusion meeting DAWN or DEFUSE-3 criteria — thrombectomy recommended., Bridging thrombolysis: Patients meeting IV alteplase/tenecteplase criteria should be thrombolysed first, but bridge to thrombectomy without waiting for its effect） Inputs: Occluded circulation Posterior (basilar artery, etc.), Imaging-confirmed intracranial large-vessel occlusion No/unconfirmed, Onset (or last-known-well) to expected puncture time > 24h, NIHSS score 12, ASPECTS score 8, Pre-stroke mRS > 1, Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) Does not meet/not assessed → Result: Thrombectomy recommendation Insufficient evidence for thrombectomy（Note: Mechanical thrombectomy mainly targets imaging-confirmed intracranial large-vessel occlusion; without a confirmed LVO, generally do not perform thrombectomy and manage as routine ischemic stroke (including IV thrombolysis assessment), Basis: Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023）