1.Indications

Occlusion: Proximal LVO (ICA, M1). Pre-stroke: mRS 0–1. Time: 0–24 h from LKW.

2.Selection by Time Window

Early Window (0–6 h)

NCCT ASPECTS ≥6 (small core). SELECT2 and ANGEL-ASPECT: large core (ASPECTS 3–5 or core >50 ml) also benefits.[+]

Late Window (6–24 h)

DAWN or DEFUSE-3 criteria. CTP or MRI to show clinical–core mismatch.[+]

3.Posterior Circulation and Distal Occlusions

Basilar: EVT up to 24 h (ATTENTION, BAOCHE). Distal/MeVO: M2/M3, ACA, PCA — by feasibility and deficit; evidence for routine EVT is limited.[+]

4.Procedural Management

Bridging: IV tPA or TNK if eligible. Do not delay transport to angio for lytic effect.[+]

Anesthesia: Conscious sedation preferred; GETA if airway or agitation.[+]

BP: Avoid hypotension. SBP >140 mmHg to support collaterals until reperfusion.[+]

ICAD: If ICAD at clot site, may need angioplasty/stent and antiplatelet load.[+]

5.Complications

Reperfusion injury (hemorrhagic transformation — strict BP). Groin: hematoma, retroperitoneal bleed, limb ischemia. Vessel: dissection, perforation, embolization to new territory.[+]