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Endovascular treatment for acute ischemic stroke - current recommendations of the European Stroke Organization

Mihael Tsalta-Mladenov, Vladina Dimitrova, Radina Fuchidzhieva, Darina Georgieva-Hristova, Silva Andonova


Acute stroke is an emergency medical condition due to acute brain circulation disorder that can lead to death or severe disability. In the acute stage of ischemic stroke, differentiated treatment with intravenous thrombolysis is recommended within 4.5 hours of symptom onset, and mechanical thrombectomy - up to 6 hours from symptom onset. A combination of both treatment methods can be considered in certain cases.

The assessment of treatment with mechanical thrombectomy is taken by a multidisciplinary team according to the relevant criteria set out in the national consensus for  treatment of acute ischemic stroke. The latest international consensus on mechanical thrombectomy, adopted by the European Stroke Organization (ESO) in 2019, introduces additional recommendations for the use of mechanical thrombectomy. The recommended larger therapeutic window for mechanical thrombectomy, up to the 24th hour of onset of symptoms, allows a greater number of patients to benefit from differentiated methods for treating ischemic stroke. It aims to reduce mortality and disability in patients suffering from the acute stage of stroke.       

The existence of numerous studies related to endovascular treatment in patients with acute ischemic stroke and the availability of additional recommendations for differentiated treatment necessitate the update of the current consensus in Bulgaria.


mechanical thrombectomy, endovascular therapy, acute ischemic stroke, thrombolysis, recommendations

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