🧠 Ischemic Stroke Endovascular Thrombectomy Indication
Judge mechanical-thrombectomy eligibility from circulation, large-vessel occlusion, time window and imaging (NIHSS/ASPECTS/mismatch). Instant, browser-side.
Clinical takeaway
Without a confirmed large-vessel occlusion on CTA/MRA, thrombectomy is not indicated — manage as routine stroke including thrombolysis assessment.
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When to use
Assess endovascular thrombectomy indication in acute ischemic stroke.
How it works
Requires imaging-confirmed intracranial LVO. Anterior circulation: ≤ 6 h with mRS 0–1, NIHSS ≥ 6, ASPECTS ≥ 6 → recommended (no perfusion needed); 6–16 h needs DAWN/DEFUSE-3 mismatch; 16–24 h needs DAWN. Posterior (basilar) within 24 h may be considered after selection. > 24 h: insufficient evidence.
Key points
- Without a confirmed large-vessel occlusion on CTA/MRA, thrombectomy is not indicated — manage as routine stroke including thrombolysis assessment.
- ≤ 6 h anterior circulation may proceed without perfusion imaging; 6–24 h requires CTP or DWI/PWI selection per DAWN/DEFUSE-3.
- Patients meeting IV thrombolysis criteria should be thrombolysed first, but bridge to thrombectomy without waiting for the drug's effect.
- Decisions also depend on the individual and the centre's capability; reperfuse as early as possible.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Occluded circulation | Anterior (ICA/MCA M1) |
|---|---|
| Imaging-confirmed intracranial large-vessel occlusion | Yes |
| Onset (or last-known-well) to expected puncture time | ≤ 6h |
| NIHSS score | 12 |
| ASPECTS score | 8 |
| Pre-stroke mRS | 0–1 |
| Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) | Meets |
→Thrombectomy recommendationThrombectomy recommended (Class I, Level A)
- Window/circulation：≤ 6h · anterior
- Assessment：Onset ≤ 6h, anterior large-vessel occlusion, pre-stroke mRS 0–1, NIHSS ≥ 6, ASPECTS ≥ 6 — thrombectomy recommended; perfusion imaging not required.
- Bridging thrombolysis：Patients meeting IV alteplase/tenecteplase criteria should be thrombolysed first, but bridge to thrombectomy without waiting for its effect
| Occluded circulation | Posterior (basilar artery, etc.) |
|---|---|
| Imaging-confirmed intracranial large-vessel occlusion | No/unconfirmed |
| Onset (or last-known-well) to expected puncture time | > 24h |
| NIHSS score | 12 |
| ASPECTS score | 8 |
| Pre-stroke mRS | > 1 |
| Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) | Does not meet/not assessed |
→Thrombectomy recommendationInsufficient evidence for thrombectomy
- Note：Mechanical thrombectomy mainly targets imaging-confirmed intracranial large-vessel occlusion; without a confirmed LVO, generally do not perform thrombectomy and manage as routine ischemic stroke (including IV thrombolysis assessment)
- Basis：Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023
Frequently asked questions
- What is Ischemic Stroke Endovascular Thrombectomy Indication?
- Judge mechanical-thrombectomy eligibility from circulation, large-vessel occlusion, time window and imaging (NIHSS/ASPECTS/mismatch). Instant, browser-side.
- How is Ischemic Stroke Endovascular Thrombectomy Indication calculated? What is the core formula?
- Requires imaging-confirmed intracranial LVO. Anterior circulation: ≤ 6 h with mRS 0–1, NIHSS ≥ 6, ASPECTS ≥ 6 → recommended (no perfusion needed); 6–16 h needs DAWN/DEFUSE-3 mismatch; 16–24 h needs DAWN. Posterior (basilar) within 24 h may be considered after selection. > 24 h: insufficient evidence.
- When is Ischemic Stroke Endovascular Thrombectomy Indication used?
- Assess endovascular thrombectomy indication in acute ischemic stroke.
- What are the key clinical points for Ischemic Stroke Endovascular Thrombectomy Indication?
- Without a confirmed large-vessel occlusion on CTA/MRA, thrombectomy is not indicated — manage as routine stroke including thrombolysis assessment. ≤ 6 h anterior circulation may proceed without perfusion imaging; 6–24 h requires CTP or DWI/PWI selection per DAWN/DEFUSE-3. Patients meeting IV thrombolysis criteria should be thrombolysed first, but bridge to thrombectomy without waiting for the drug's effect. Decisions also depend on the individual and the centre's capability; reperfuse as early as possible.
- What are the limits and cautions when using Ischemic Stroke Endovascular Thrombectomy Indication?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Ischemic Stroke Endovascular Thrombectomy Indication calculated in practice? Can you show a worked example?
- Inputs: Occluded circulation Anterior (ICA/MCA M1), Imaging-confirmed intracranial large-vessel occlusion Yes, Onset (or last-known-well) to expected puncture time ≤ 6h, NIHSS score 12, ASPECTS score 8, Pre-stroke mRS 0–1, Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) Meets → Result: Thrombectomy recommendation Thrombectomy recommended (Class I, Level A)（Window/circulation: ≤ 6h · anterior, Assessment: Onset ≤ 6h, anterior large-vessel occlusion, pre-stroke mRS 0–1, NIHSS ≥ 6, ASPECTS ≥ 6 — thrombectomy recommended; perfusion imaging not required., Bridging thrombolysis: Patients meeting IV alteplase/tenecteplase criteria should be thrombolysed first, but bridge to thrombectomy without waiting for its effect） Inputs: Occluded circulation Posterior (basilar artery, etc.), Imaging-confirmed intracranial large-vessel occlusion No/unconfirmed, Onset (or last-known-well) to expected puncture time > 24h, NIHSS score 12, ASPECTS score 8, Pre-stroke mRS > 1, Perfusion/clinical-core mismatch (meets DAWN/DEFUSE-3) Does not meet/not assessed → Result: Thrombectomy recommendation Insufficient evidence for thrombectomy（Note: Mechanical thrombectomy mainly targets imaging-confirmed intracranial large-vessel occlusion; without a confirmed LVO, generally do not perform thrombectomy and manage as routine ischemic stroke (including IV thrombolysis assessment), Basis: Chinese Guideline for Endovascular Treatment of Acute Ischemic Stroke 2023）