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IMPORTANT: For use by qualified healthcare professionals only. Mechanical Thrombectomy EVT is a structured 8-step endovascular treatment pathway for large vessel occlusion stroke. Built for stroke physicians, neurologists, interventional neuroradiologists, and ED doctors. Dark navy design with live countdown timer and four interactive calculators. Full references throughout. LVO ACTIVATION AND IMMEDIATE CHECKLIST Simultaneous team activation: stroke consultant, neuroradiology, INR, anaesthetics, ICU, catheter lab. Patient checklist: onset time, IV access, NIHSS, BP, pre-morbid mRS, direct CT transfer. LVO indicators: NIHSS 10 or above, forced gaze deviation, hyperdense MCA sign. Low NIHSS does NOT exclude LVO -- 15% of LVOs present with NIHSS 5 or below. HERMES 2016: every 15-min delay = 4% reduction in good outcome. RACE AND LAMS SCORE CALCULATORS RACE (0-9): facial palsy, arm/leg motor, gaze deviation, aphasia -- threshold 5 or above: direct TCC. LAMS (0-5): facial droop, arm drift, grip -- sensitivity 81%, specificity 89% (Llanes 2017), threshold 4 or above. Mothership (direct TCC within 30 min extra) vs drip-and-ship. CT TRIFECTA AND ASPECTS CALCULATOR NCCT plus CTA plus CTP as single simultaneous protocol -- door-to-CTA under 40 minutes. Ten-region interactive ASPECTS calculator: tap MCA territory regions (caudate, lentiform, IC, insular ribbon, M1-M6), score updates live. ASPECTS 6 or above: standard EVT. ASPECTS 3-5: ANGEL-ASPECT/SELECT-MR criteria. CTP for core-penumbra mismatch. EVT ELIGIBILITY Standard 0-6h (HERMES): LVO on CTA, ASPECTS 6 or above, mRS 0-2, NIHSS 6 or above. No upper age limit. Extended 6-24h: DEFUSE-3 (core below 70mL, mismatch 1.8+) and DAWN (age-stratified thresholds). Wake-up stroke: DWI-FLAIR mismatch. Large core ASPECTS 3-5: ANGEL-ASPECT/SELECT-2 -- discuss all with INR. IVT BRIDGE THERAPY AND LIVE DOSE CALCULATOR Tenecteplase 0.25 mg/kg IV bolus (max 25mg, preferred): EXTEND-IA TNK superior recanalisation 37% vs 22%. Give in CT scanner and transfer immediately. Alteplase 0.9 mg/kg if unavailable. Live weight-based dose calculator: enter weight, select TNK or alteplase -- instant doses. IVT does not replace EVT in LVO. EVT PROCEDURE AND TIME TARGETS Pre-EVT checklist: consent, SIESTA conscious sedation preferred, BP 140-180 until reperfusion. Techniques: stent retriever, contact aspiration (ASTER), combined SAVE/SWIM. mTICI grading 0 through 3 with colour badges. SSNAP targets: door-to-CT under 25 min, door-to-needle under 45 min, door-to-groin under 90 min, groin-to-reperfusion under 60 min. POST-EVT CARE -- FIRST 24 HOURS BP by mTICI: reperfusion 2b-3 target SBP below 160 (avoid below 120); failed 0-2a permissive 140-180; haemorrhagic transformation below 140 urgently. Monitoring: hourly neuro obs, groin checks x6h, CT at 22-36h, aspirin and statin at 24h. ECASS HT classification HI-1 through PH-2. Decompressive hemicraniectomy: HAMLET/DESTINY/DECIMAL, mortality 80% to 29%. DOCUMENTATION AND SECONDARY PREVENTION SSNAP: time targets, mTICI, complications, 24h CT, discharge NIHSS and mRS. Secondary prevention: clopidogrel, DOAC if AF (TIMING trial day 3-4), atorvastatin, antihypertensive at 72h, swallow, aetiology workup, driving advice (1 month minimum), clinic 4-6 weeks. REFERENCES 17 cited sources, 23 inline badges. HERMES; DAWN; DEFUSE-3; ANGEL-ASPECT; SELECT-2; EXTEND-IA TNK; ECASS-3; WAKE-UP; RACE; LAMS; ASPECTS; SIESTA; HAMLET/DESTINY/DECIMAL; NICE NG128; RCP 2023; AHA/ASA 2019. Live countdown timer. Font A- / A+ adjustment. No login. No patient data stored. DISCLAIMER For qualified healthcare professionals only. All EVT decisions require direct neurology and INR consultant input. Does not replace clinical judgement or specialist review. Dr Atif Elnil MBBS MRCP UK © © 2026 Dr Atif Elnil. All rights reserved. |
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Thrombectomy – ATIF ELNIL
5月 17, 2026 | コメントは受け付けていません。
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