Mechanical Thrombectomy in the Late Presentation of Anterior Circulation Large Vessel Occlusion Stroke: A Guideline From the Society of Vascular and Interventional Neurology Guidelines and Practice Standards Committee

Background Recent clinical trials investigating endovascular therapy in the extended time window have opened new treatment paradigms for patients with late‐presenting large vessel occlusion stroke. The aim of this guideline is to provide up‐to‐date recommendations diagnosis, selection, and medical or presenting window. Methods Society Vascular Interventional Neurology Guidelines Practice Standards committee assembled a writing group recruited interdisciplinary experts review evaluate current literature. Recommendations were assigned by using Class Recommendation/Level Evidence algorithm format. final was approved all members group, committee, board directors. Results Literature yielded 3 high‐quality randomized several observational studies that been extracted derive enclosed summary recommendations. In 6‐ 24‐hour clinical–imaging mismatch as defined DAWN (Diffusion‐Weighted Imaging Computed Tomography Perfusion Assessment With Clinical Mismatch Triage Wake‐Up Late Presenting Strokes Undergoing Neurointervention Trevo) DEFUSE (Endovascular Therapy Following Evaluation Ischemic Stroke) studies, recommended. Noncontrast computed tomography can be used infarct size sole imaging modality patient particularly when access perfusion magnetic resonance limited if their performance would incur substantial delay treatment. addition, questions reviewed based on available evidence consensus grading. Conclusions These guidelines practical recent stroke