This is the current release of the guideline.

Acute stroke

Counseling
Treatment

Emergency Medicine
Neurology
Radiology

Physicians

To make a statement regarding intraarterial thrombolytic therapy

Individuals with acute stroke

1. Counseling patients and their families regarding the benefits and risks of intraarterial thrombolytic therapy
2. Intraarterial thrombolytic therapy
3. Appropriate training and credentialing of physicians performing emergency cerebral thrombolysis

Not stated

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not applicable

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

Prior to PROACT II trial results, it had been the consensus opinion of the American Society of Interventional and Therapeutic Neuroradiology (ASITN) and the Society of Interventional Radiology (SIR) that intraarterial thrombolytic therapy for acute stroke was investigational. Although the results of the trial did not lead to Food and Drug Administration (FDA) approval of a specific drug, the results of this trial are convincing evidence that intraarterial thrombolytic therapy can now be considered an acceptable and appropriate therapy for acute stroke.

The ASITN and SIR believe that use of the technique of intraarterial thrombolysis in selected patients is appropriate, while ongoing research will better define the parameters of such intervention. The magnitude of neurologic deficit, nature of the arterial occlusive lesion, and time to treatment are among the factors that should be taken into account in counseling patients and their families regarding the benefits and risks of intraarterial thrombolytic therapy.

The ASITN and SIR believe individuals performing emergency cerebral thrombolysis should be well trained and experienced in cerebral angiography, and appropriately credentialed in their hospital for doing such. These individuals should maintain records of their indications, successes, complications, and outcomes for cerebral angiography according to the published guidelines.

Whereas experience and training in interventional stroke therapy ideally are achieved in a recommended program, other individuals with formal training and experience might appropriately perform thrombolysis. We believe minimum standards for credentialing for cerebral angiography and thrombolytic intervention should reflect the principles espoused therein.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Appropriate interventional therapy in acute stroke

Risks of intraarterial thrombolytic therapy

The clinical practice guidelines of the Society of Interventional Radiology (SIR) attempt to define practice principles that generally should assist in producing high quality patient care. These guidelines are voluntary and are not rules. A physician may deviate from these guidelines, as necessitated by the individual patient and available resources. These practice guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care that are reasonably directed towards the same result. Other sources of information may be used in conjunction with these principles to produce a process leading to high quality medical care. The ultimate judgment regarding the conduct of any specific procedure or course of management must be made by the physician, who should consider all circumstances relevant to the individual clinical situation. Adherence to the SIR Quality Improvement Program will not assure a successful outcome in every situation. It is prudent to document the rationale for any deviation from the suggested practice guidelines in the department policies and procedure manual or in the patient's medical record.

An implementation strategy was not provided.

Getting Better

Effectiveness
Patient-centeredness
Safety

Not applicable: The guideline was not adapted from another source.

2003 Sep

Society of Interventional Radiology - Medical Specialty Society

Society of Interventional Radiology

Standards of Practice Committee

Not stated

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on January 18, 2005. The information was verified by the guideline developer on January 21, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.