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Recommendations

1. Patients eligi le !o" int"a#eno$s "tPA s%o$ld "ecei#eint"a#eno$s "tPA e#en i! int"a&a"te"ial t"eatments a"eeing conside"ed (Class I; Level of Evidence A) .'(nc)anged *rom t)e revious guideline+,-

'. (nt"a&a"te"ial ) "inol*sis is ene)cial !o" t"eatmento! ca"e!$ll* selected +atients ,it% ma-o" isc%emicst"o es o! /0 %o$"s d$"ation ca$sed * occl$sions o!t%e MCA ,%o a"e not ot%e",ise candidates !o"int"a#eno$s "tPA (Class I; Level of Evidence B) .T%e o+timal dose o! int"a&a"te"ial "tPA is not ,ellesta lis%ed2 and "tPA does not %a#e 3DA a++"o#al !o"int"a&a"te"ial $se . 'Revised *rom t)e revious guideline+,-

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Recommendations

4. As ,it% int"a#eno$s ) "inol*tic t%e"a+*2 "ed$cedtime !"om s*m+tom onset to "e+e"!$sion ,it%int"aa"te"ial t%e"a+ies is %ig%l* co""elated ,it%ette" clinical o$tcomes2 and all e5o"ts m$st e

$nde"ta en to minimi6e dela*s to de)niti#e t%e"a+*(Class I; Level of Evidence B) . 'Ne recommendation-

7. (nt"a&a"te"ial t"eatment "e8$i"es t%e +atient toe at an e9+e"ienced st"o e cente" ,it% "a+idaccess to ce"e "al angiog"a+%* and 8$ali)edinte"#entionalists. An em+%asis on e9+editio$sassessment and t"eatment s%o$ld e made.3acilities a"e enco$"aged to de)ne c"ite"ia t%at cane $sed to c"edential indi#id$als ,%o can +e"!o"mint"a&a"te"ial "e#asc$la"i6ation +"oced$"es.

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Recommendations:. ;%en mec%anical t%"om ectom* is +$"s$ed2 stent "et"ie#e"ss$c% as Solitai"e 3R and T"e#o a"e gene"all* +"e!e""ed to coil"et"ie#e"s s$c% as Me"ci (Class I; Level of Evidence A) . T%e"elati#e e5ecti#eness o! t%e Pen$m "a S*stem #e"s$s stent"et"ie#e"s is not *et c%a"acte"i6ed. 'Ne recommendation-

0. T%e Me"ci2 Pen$m "a S*stem2 Solitai"e 3R2 and T"e#ot%"om ectom* de#ices can e $se!$l in ac%ie#ing "ecanali6ation alone o" in com ination ,it% +%a"macological) "inol*sis in ca"e!$ll* selected +atients (Class IIa; Level ofEvidence B) . T%ei" a ilit* to im+"o#e +atient o$tcomes %as not

*et een esta lis%ed.

T%ese de#ices s%o$ld contin$e to e st$died in "andomi6edcont"olled t"ials to dete"mine t%e e

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Recommendations

=. (nt"a&a"te"ial ) "inol*sis o" mec%anicalt%"om ectom* is "easona le in +atients ,%o %a#econt"aindications to t%e $se o! int"a#eno$s) "inol*sis (Class IIa; Level of Evidence C) .

'Revised *rom t)e revious guideline+,- >. Resc$e int"a&a"te"ial ) "inol*sis o" mec%anicalt%"om ectom* ma* e "easona le a++"oac%es to "ecanali6ation in +atients ,it% la"ge&a"te"*occl$sion ,%o %a#e not "es+onded to int"a#eno$s) "inol*sis.Additional "andomi6ed t"ial data a"e needed(Class IIb; Level of Evidence B) . 'Nerecommendation-

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Recommendations

?. T%e $se!$lness o! mec%anicalt%"om ectom* de#ices ot%e" t%an t%e Me"ci"et"ie#e"2 t%e Pen$m "a S*stem2 Solitai"e 3R2and T"e#o is not ,ell esta lis%ed (Class IIb;Level of Evidence C) . T%ese de#ices s%o$ld e$sed in t%e setting o! clinical t"ials. 'Revised*rom t)e revious guideline+,-

1@. T%e $se!$lness o! eme"gent int"ac"anialangio+last* and o" stenting is not ,ellesta lis%ed. T%ese +"oced$"es s%o$ld e $sedin t%e setting o! clinical t"ials (Class IIb; Level

of Evidence C) . 'Ne recommendation-.

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Recommendations

11. T%e $se!$lness o! eme"gent angio+last*and o" stenting o! t%e e9t"ac"anial ca"otid o"#e"te "al a"te"ies in $nselected +atients isnot ,ell esta lis%ed (Class IIb; Level ofEvidence C) .

1'.& Use o! t%ese tec%ni8$es ma* e conside"ed in ce"tain ci"c$mstances2 s$c% as

in t%e t"eatment o! ac$te isc%emic st"o e"es$lting !"om ce"#ical at%e"oscle"osis o"dissection (Class IIb; Level of Evidence C) . Additional "andomi6ed t"ial data a"e needed.

'Ne recommendation-

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Solitai"e 3R De#ice

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Solitai"e 3R De#ice

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Solitai"e 3R De#ice

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Solitai"e 3R De#ice

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Solitai"e 3R De#ice

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T"e#o BP

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T"e#o BP

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T"e#o BP

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P$ licaciones(ltimos años.

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T%is a"ticle ,as +$ lis%ed on 3e "$a"* 112 '@1:2 atNEJM.o"g.N Engl J Med '@1: 4=' 1@1?&4@.

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T%is a"ticle ,as +$ lis%ed on A+"il 1=2 '@1:2 at

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T%is a"ticle ,as +$ lis%ed on A+"il 1=2 '@1:2 at NEJM.o"g.DO( 1@.1@:0 NEJMoa1:@4=>@

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