LVO Protocol
Patient Selection
All patients presenting with concern for stroke should undergo the following imaging:
- Non-contrast CT head
- MRI wake-up protocol when indicated ASPECTS measurement on CT or DWI-MRI
- CTA head and neck
- MRI wake-up protocol when indicated
- CTP when indicated
- ASPECTS measurement on CT or DWI-MRI
Background
ASPECTS Score
- ASPECTS 6-10
- Should receive EVT when presenTIng <24 hours from LKW
- ASPECTS 3-5
- Do not exclude from treatment with EVT when presenting <12 hours from LKW
- CTP if presenting >12 hours from LKW
- Should receive EVT if core infarct volume ≤125mL
- May be reasonable to proceed with EVT following discussion with family for core infarct >125mL
- ASPECTS 0-2
- Do not exclude from treatment with EVT when presen ng <6 hours from LKW
- CTP if presenting >6 hours from LKW
- Should receive EVT if core infarct volume ≤125mL
- May be reasonable to proceed with EVT following discussion with family for core volume >125mL
References
Bendszus M, Fiehler J, Sub l F, et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet. 2023;402(10414):1753-1763. doi:10.1016/S0140-6736(23)02032-9 (TENSION)
Costalat V, Jovin TG, Albucher JF, et al. Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size. N Engl J Med. 2024;390(18):1677-1689. doi:10.1056/NEJMoa2314063 (LASTE)
Huo X, Ma G, Tong X, et al. Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med. 2023;388(14):1272-1283. doi:10.1056/NEJMoa2213379 (ANGEL-ASPECTS)
Sarraj A, Hassan AE, Abraham MG, et al. Trial of Endovascular Thrombectomy for Large Ischemic Strokes [published correc on appears in N Engl J Med. 2024 Jan 25;390(4):388]. N Engl J Med. 2023;388(14):1259-1271. doi:10.1056/NEJMoa2214403 (SELECT-2)
Yoshimura S, Sakai N, Yamagami H, et al. Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med. 2022;386(14):1303-1313. doi:10.1056/NEJMoa2118191 (RESCUE-Japan LIMIT)