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## Complete Summary

#### GUIDELINE TITLE

Emergency interventional stroke therapy: a statement from the American
Society of Interventional and Therapeutic Neuroradiology and the Society
of Interventional Radiology.

#### BIBLIOGRAPHIC SOURCE(S)

Emergency interventional stroke therapy. A statement from the American
Society of Interventional and Therapeutic Neuroradiology and the Society
of Interventional Radiology. J Vasc Interv Radiol 2003 Sep;14(9 Pt
2):S385. \[3 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14514851)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Acute stroke

#### GUIDELINE CATEGORY

Counseling\
Treatment

#### CLINICAL SPECIALTY

Emergency Medicine\
Neurology\
Radiology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To make a statement regarding intraarterial thrombolytic therapy

#### TARGET POPULATION

Individuals with acute stroke

#### INTERVENTIONS AND PRACTICES CONSIDERED

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

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not applicable

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

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

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

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.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

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

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate interventional therapy in acute stroke

#### POTENTIAL HARMS

Risks of intraarterial thrombolytic therapy

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness\
Safety

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Emergency interventional stroke therapy. A statement from the American
Society of Interventional and Therapeutic Neuroradiology and the Society
of Interventional Radiology. J Vasc Interv Radiol 2003 Sep;14(9 Pt
2):S385. \[3 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14514851)

#### ADAPTATION

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

#### DATE RELEASED

2003 Sep

#### GUIDELINE DEVELOPER(S)

Society of Interventional Radiology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

Society of Interventional Radiology

#### GUIDELINE COMMITTEE

Standards of Practice Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[Society of Interventional Radiology Web
site](http://www.sirweb.org/clinical/cpg/S385.pdf).

Print copies: Available from the Society of Interventional Radiology,
10201 Lee Highway, Suite 500, Fairfax, VA 22030

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

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

#### COPYRIGHT STATEMENT

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

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008