VJVirtual | ESO-ESMINT expedited recommendation on IVT before MT in acute ischemic stroke

Mechanical thrombectomy (MT) has shown encouraging results in single-arm studies and is a standard of care treatment for patients with large vessel occlusion (LVO) ischemic stroke. Several randomized controlled clinical trials have assessed whether MT alone is non-inferior to intravenous thrombolysis (IVT) plus MT within 4.5 hours in patients with anterior circulation LVO ischemic stroke and no contraindication to IVT. However, controversy remains regarding the benefit of adjunctive IVT in these patients. Guillaume Turc, MD, PhD, University of Paris, Paris, France, and Jens Fiehler, MD, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, share the recently developed European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) expedited recommendation on IVT before MT in patients with acute ischemic stroke and anterior circulation LVO. The guideline was prepared according to ESO standard operating procedures based on the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The working group recommends IVT plus MT over MT alone for patients admitted to a MT-capable center within 4.5 hours of symptom onset and eligible for both treatments. For stroke patients admitted to a center without MT facilities and eligible for IVT ≤4.5 hours and MT, IVT followed by rapid transfer to a MT-capable center is recommended. Additionally, an expert consensus statement was provided on ischemic stroke on awakening from sleep: they suggest IVT plus MT over MT alone in selected patients. This interview was recorded during an online conference call with The Video Journal of Neurology (VJNeurology).