IV: intravenous; tPA: tissue plasminogen activator (alteplase or tenecteplase); CTA: computed tomography angiography; MRA: magnetic resonance angiography; LAO: large artery occlusion; MT: mechanical thrombectomy; ASPECTS: Alberta Stroke Program Early CT Score; NIHSS: National Institutes of Health Stroke Scale; CT: computed tomography; MRI: magnetic resonance imaging; mRS: modified Rankin Scale; MCA: middle cerebral artery; ICA: internal carotid artery; FLAIR: fluid-attenuated inversion recovery.
* Patients are not ordinarily eligible for IV tPA unless the time last known to be well is <4.5 hours. However, imaging-based criteria (ie, MRI showing an acute ischemic lesion that is diffusion positive and FLAIR negative) is an option at expert stroke centers to select patients with wake-up stroke or unknown stroke onset time for IV tPA. Refer to associated UpToDate topics for details.
¶ Usually assessed with MRA or CTA, less often with digital subtraction angiography.
Δ There is intracranial arterial occlusion of the distal ICA, middle cerebral (M1/M2), or anterior cerebral (A1/A2) artery by CTA, MRA, or digital subtraction angiography.
◊ MT may be a treatment option for patients with acute ischemic stroke caused by occlusion of the basilar artery, vertebral arteries, or posterior cerebral arteries at expert stroke centers, but benefit is uncertain.
§ Based upon data from the Aurora study[1].