The new ESO Guidelines on Mechanical Thrombectomy were recently published in the European Stroke Journal, providing a range of recommendations relating to prehospital management, patient selection (using clinical and imaging characteristics), and treatment.

In general, the guidelines provide eligibility criteria for stroke patients with large vessel occlusion presenting to hospital within 24 hours of onset, with imaging cited as a leading factor in the decision-making process across the spectrum.

For patients within the 0-6 hours’ time window, thrombectomy is recommended if the patient exhibits an ASPECTS > 6 on non-contrast CT, or with an infarct volume < 70 ml. Advanced imaging is deemed unnecessary at this stage, allowing for the utilization of platforms such as Brainomix’s e-ASPECTS®.

For patients presenting within 6-12 hours of stroke onset, the guidelines recommend thrombectomy if the patient exhibits an ASPECTS > 6 with moderate-to-good collateral circulation (CTA-CS > 2), which can be assessed with Brainomix’s e-CTA® platform, negating the need for advanced imaging systems for patients in this time period.

For patients presenting within the 12-24 hours’ time window, eligibility for thrombectomy is based upon the selection criteria of the DEFUSE-3 or DAWN trials. The new guidelines support the use of any advanced imaging system that can deliver an assessment of CT Perfusion images with an estimated infarct core volume, such as Brainomix’s e-Mismatch platform powered by Olea Sphere, which enables clinicians to make a more informed treatment decision for late-window patients.

Brainomix’s e-Stroke Suite® is the most comprehensive imaging solution, empowering clinicians across all stages of the stroke patient pathway and supporting the thrombectomy decision-making process, from non-contrast CT interpretation, to collateral assessments and LVO detection, to more advanced perfusion-based assessments.