Executive Summary
Appropriate patients may be eligible for mechanical thrombectomy whether or not they have previously received intravenous t-PA, and whether or not they presented to a center capable of this specialized technique. Based on several recent randomized controlled trials, mechanical treatment reduces long-term disability in properly selected patients with acute ischemic stroke due to large vessel occlusions. Estimates of the “Number Needed to Treat” (NNT) are on the order of 5 or less. Few medical therapies offer such a low NNT. However, intra-arterial thrombectomy is a highly specialized technique that is available at only a limited number of centers. Hospitals that are unable to perform intra-arterial thrombectomy should develop protocols and transfer arrangements in preparation for patients that will meet treatment criteria. Systems of care should be put in place by institutions, state health authorities and local EMS agencies; individual emergency physicians at hospitals not capable of performing thrombectomy should not be expected to invent a process from scratch for each individual patient. These preparations will enable emergency physicians to have the highest likelihood of being able to offer state of the art therapy for AIS, even if patients present to a facility with limited stroke treatment resources.
