STROKE-ECR CRITERIA, STROKE 6 TO 24 HRS

SUMMARY

CRITERIA
1. Stroke patients treatable within 6‐24 hours of defined stroke onset or time last known well in wake up stroke, ECR treatment decision requires a small infarct core size on CTP or MRI
2. Patient has a pre‐morbid modified Rankin Scale (mRS) < 2
3. An acute neurological deficit (NIHSS > 10)

4. Imaging:
a. Non‐contrast CT shows absence of a large infarction (> 1/3 MCA territory) or a haemorrhage

b. CTA (aortic arch to vertex) shows a large vessel occlusion of the IC, M1 or the Basilar artery (there is some evidence for M2, particularly proximal)
c. CT perfusion or MRI scan shows mismatch between severity of clinical stroke deficits and an infarct core size of < 70 mls, estimated from CTP or MRI imaging (DEFUSE 3 criteria)

EVIDENCE
Evidence suggests for patients with ischaemic stroke caused by a large vessel occlusion in the ICA, proximal M1 segment, or with tandem occlusion of both the cervical carotid and intracranial large arteries, endovascular thrombectomy should be undertaken when the procedure can be commenced between 6-24 hours after they were last known to be well if clinical and CT perfusion or MRI features indicate the presence of salvageable brain tissue (Nogueira et al. 2017, Albers et al. 2018).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].