IAT Evidence Summary
Endovascular Recanalization Therapy
Korean Stroke Society Guidelines
Comprehensive guidelines on the latest recommendations for endovascular recanalization therapy (ERT) in acute ischemic stroke, neuroimaging evaluation, and system organization.
This page is scheduled to be updated along with other guidelines.
Evidence Level and Recommendation Grade
Level of Evidence (LOE)
IIa Well-designed randomized controlled trials
III Non-randomized controlled studies
IV Expert opinion
GPP Good practice point
Grade of Recommendation (GOR)
B Recommended
C May be considered
For acute major ischemic stroke due to anterior circulation (internal carotid artery, M1, large M2 branches) large vessel occlusion, ERT is recommended within 6 hours to improve clinical outcomes
In patients eligible for intravenous tissue plasminogen activator (IV-TPA), IV-TPA administration before ERT initiation is recommended. To avoid significant delay of ERT by IV-TPA, concurrent ERT during IV-TPA treatment is recommended without waiting for IV-TPA clinical response
For acute major ischemic stroke due to anterior circulation large vessel occlusion in patients with IV-TPA contraindications, ERT as first-line treatment is recommended within 6 hours
For acute major ischemic stroke due to posterior circulation (basilar artery, P1, vertebral artery) large vessel occlusion, ERT may be considered within 6 hours
For selected patients with acute ischemic stroke due to anterior circulation large vessel occlusion presenting within 6-24 hours after last known normal, endovascular recanalization may be recommended when target mismatch is assessed by multimodal imaging and/or clinical deficit and patient outcome improvement is expected with ERT. For patient selection, each institution is recommended to reasonably define its own imaging methods to timely identify target mismatch in the late time window
For selected patients with acute ischemic stroke due to posterior circulation large vessel occlusion presenting after 6 hours, ERT may be considered in patients with favorable multimodal imaging profiles considering risks and benefits. Each center is recommended to define its own patient selection criteria
When indicated, ERT should be started as soon as possible
Stent retriever thrombectomy is recommended as first-line ERT
If recanalization is not achieved with stent retriever thrombectomy, addition of other ERT methods may be considered after considering expected efficacy and safety
Other mechanical thrombectomy or thromboaspiration devices may be considered as first-line methods at the discretion of the interventionalist after considering technical aspects
Conscious sedation is generally preferred over general anesthesia during ERT. However, decisions should be made considering patient condition and center experience
Time Window
Anterior circulation: 0-6 hours (strong recommendation)
Anterior circulation: 6-24 hours (imaging selection)
Posterior circulation: 0-6 hours (may be considered)
Posterior circulation: >6 hours (individual assessment)
First-line Treatment
Stent retriever (LOE Ia, GOR A)
Conscious sedation preferred
IV-TPA + ERT concurrent
Start as soon as possible
Imaging Requirements
Non-contrast CT/MRI (exclude hemorrhage)
CTA/MRA (confirm large vessel occlusion)
Multimodal imaging (6-24 hour window)
Perfusion/diffusion mismatch assessment