Chinese stroke association guidelines on reperfusion therapy for acute ischaemic stroke 2024
Yunyun Xiong1,2, Shuya Li1,2, Chunjuan Wang1,2
1Department of Neurology, Beijing Tiantan Hospital, Beijing, China.
Insights
This guideline updates recommendations for reperfusion therapy in acute ischaemic stroke, including thrombolysis and thrombectomy. It provides the latest evidence to help clinicians optimize patient selection and treatment decisions for better stroke outcomes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Stroke is a leading global health issue, with China facing a high burden of ischaemic stroke.
- Reperfusion therapies, including thrombolysis and thrombectomy, significantly improve outcomes for acute ischaemic stroke.
- Recent trials have expanded the use and efficacy of thrombolytic agents and thrombectomy procedures.
Purpose of the Study:
- To provide updated, evidence-based guidelines for reperfusion therapy in acute ischaemic stroke.
- To incorporate the latest clinical trial data on thrombolytic agents and mechanical thrombectomy.
- To assist clinicians in optimizing patient selection and treatment strategies.
Main Methods:
- Development of guidelines by the Chinese Stroke Association (CSA) writing group.
- Comprehensive literature search of MEDLINE (PubMed) up to September 30, 2024.
- Expert consensus and evidence grading using CSA's Guideline Development Manual.
Main Results:
- The guideline details patient selection criteria for thrombolysis and thrombectomy.
- It summarizes current evidence on various thrombolytic drug options for informed decision-making.
- Includes practical flow charts for rapid implementation of intravenous thrombolysis and mechanical thrombectomy.
Conclusions:
- The guideline represents an update on advancements in acute ischaemic stroke reperfusion therapy.
- Future research is expected to focus on novel thrombolytic agents and expanded treatment indications.
- These updated recommendations aim to improve clinical practice and patient outcomes in China and beyond.
Background:
Stroke remains a major global health challenge, with China experiencing a significant burden due to its high incidence and severe outcomes. Reperfusion therapies, such as intravenous thrombolysis and endovascular thrombectomy, have shown substantial benefits in improving early outcomes for ischaemic stroke. Recent clinical trials have validated the safety and efficacy of a broader range of thrombolytic agents and expanded the eligible patient populations for both intravenous thrombolysis and mechanical thrombectomy. This guideline aims to provide the latest evidence-based insights in the field of reperfusion therapy.
Methods:
The Chinese Stroke Association (CSA) established a writing group to develop updated guidelines on reperfusion therapy for acute ischaemic stroke. A comprehensive search of MEDLINE (via PubMed) was conducted up to 30 September 2024. Experts in the field of stroke engaged in extensive discussions, both online and offline, to evaluate the latest evidence. Each recommendation was graded using the CSA's class of recommendation and level of evidence in the Guideline Development Manual of the CSA.
Results:
This guideline, reviewed and approved by the CSA Guidelines Writing Group, outlines the criteria for patient selection for thrombolysis and thrombectomy and summarises the latest evidence on various thrombolytic drug options to support decision-making in reperfusion therapy. Additionally, the guideline includes green channel flow charts for intravenous thrombolysis and mechanical thrombectomy, designed to assist clinicians in optimising their clinical decisions.
Conclusion:
This guideline updates the latest advancements in the field of reperfusion therapy for acute ischaemic stroke. It is anticipated that future clinical research will further advance areas such as innovative thrombolytic agents, expanded indications for thrombolysis and mechanical thrombectomy.
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