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2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke
Open accessAbstract
Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset, since five landmark ERT trials conducted by 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window of up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch, defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thoroughly reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient.
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Standard stroke care includes medical treatment, routine stroke therapy, and rehabilitative exercises, as outlined in basic guidelines.
“Standard stroke care includes medical treatment, routine stroke therapy, and rehabilitative exercises, as outlined in the basic guidelines [35,36].”
From Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility (2024) · cites this paper as [35]
The Previous guidelines > Endovascular recanalization therapy section recommends IV-TPA for eligible patients and endovascular treatment for selected patients with acute ischemic stroke. It does not describe routine stroke therapy or rehabilitative exercises as components of standard care, so it supports only the medical-treatment portion of the claim. (LLM, conf=0.84)
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“Several studies have clearly demonstrated that patients with good collateral circulation had a greater benefit from ERT.”
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MethodCanadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015
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“In addition, MRI versus CT was comparable to detect hemorrhagic stroke or acute vascular lesion.(30,31) In addition, for potential ERT candidates, an LAO should be confirmed by non-invasive vascular imaging (CTA or MR angiography).”
ResultAccuracy and Reliability Assessment of CT and MR Perfusion Analysis Software Using a Digital Phantom
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“For the decision making for ERT, the participating investigators used non-contrast CT, CT angiogram (CTA), and CTP of their own routine protocols, and were instructed not to use the RAPID software.(13) Among the total of 190 patients treated with ERT based on their clinical and imaging features, 131 patients (69%) wer…”
MethodEligibility for Endovascular Trial Enrollment in the 6- to 24-Hour Time Window
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“The international stroke expert groups strongly recommend to assess collateral circulation assessment as well as LAO, ischemic core, and target mismatch for potential ERT candidates.(27) The Canadian guidelines also suggest that moderate-to-good collateral status on CTA predict a better response to ERT.”
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“According to the guidelines, the benefit of ERT was uncertain after 6 hours of symptom onset.(7,10) Specifically, the previous Korean guidelines recommended that “ERT can be considered for patients having favorable multimodal imaging profiles regarding expected benefit and safety (LOE IV, GOR C).”
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BackgroundInfluentialPathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke
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Self-citationQuality of stroke guidelines in low- and middle-income countries: a systematic review
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Self-citationClinical prognosis of isolated anterior cerebral artery territory infarction: a retrospective study
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Self-citationDelayed Recanalization—How Late Is Not Too Late?
Kang, R., Gamdzyk, M., Tang, H. C., Luo, Y., Lenahan, C., & Zhang, J. H. (2020) · Translational Stroke Research · doi:10.1007/s12975-020-00877-y · Cited by 16
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“후방 순환계 대동맥 폐색 환자에서도 혈전제거술을 시행을 권고하고 있다(23).”
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Self-citationChanges in Informed Consent Policy and Treatment Delays in Stroke Thrombolysis
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Update of the Korean Clinical Practice Guidelines for Stroke: Blood Pressure Management
Jeong, H. S., Park, H., Park, J., Ko, S., Seo, W., Heo, S. H., Oh, M. S., Kim, J., Lee, H., Park, S., et al. (2025) · Journal of Clinical Neurology · doi:10.3988/jcn.2025.0177 · Cited by 5
Self-citationBenalia, V. H. C., Aghaebrahim, A., Cortez, G. M., Sauvageau, E. A., & Hanel, R. A. (2023) · Interventional Neuroradiology · doi:10.1177/15910199231163046 · Cited by 5
Koh, S., Park, S. Y., Liebeskind, D. S., Choi, J. W., Kim, H., Choi, J. Y., Kim, M., Lee, S., Hong, J. M., & Lee, J. S. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.030936 · Cited by 5
Kim, H. J., Park, M., Yoo, J., Kim, Y. D., Park, H., Kim, B. M., Bang, O. Y., Kim, H. C., Han, E., Kim, D. J., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11010274 · Cited by 5
Self-citationPark, D., Lee, S. Y., Jeong, E., Hong, D., Kim, M.-C., Choi, J.-H., Shin, E. K., Son, K. J., & Kim, H. S. (2022) · Scientific Reports · doi:10.1038/s41598-022-08025-2 · Cited by 5
Navarro‐Flores, A., Alarcon-Ruiz, C. A., Morán‐Mariños, C., Taype-Rondán, Á., Sequeiros, J. M., Alva‐Díaz, C., & Zafra‐Tanaka, J. H. (2021) · World Neurosurgery · doi:10.1016/j.wneu.2021.08.053 · Cited by 4
Jung, W. S., Seo, K., & Suh, S. H. (2022) · Neurointervention · doi:10.5469/neuroint.2022.00234 · Cited by 4
Self-citationOk, T., Yoon, P. H., Kim, G. S., & Seo, K. (2022) · Journal of Korean Medical Science · doi:10.3346/jkms.2022.37.e358 · Cited by 4
Reporting quality evaluation of the stroke clinical practice guidelines: a systematic review
Lu, S., Luo, X., Ni, X., Li, H., Meng, M., Cai, Y., Liu, Y., Ren, M., Sun, Y., & Chen, Y. (2021) · Systematic Reviews · doi:10.1186/s13643-021-01805-3 · Cited by 5
Park, E. H., Hwang, S.-S., Oh, J., Kim, B. J., Bae, H., Yang, K. H., Choi, A. R., Kang, M. Y., & Subramanian, S. V. (2023) · Journal of Preventive Medicine and Public Health · doi:10.3961/jpmph.22.318 · Cited by 3
Self-citationMormina, E., Tessitore, A., Cavallaro, M. F. M., Caragliano, A. A., Buonomo, O., Longo, M., Granata, F., Caponnetto, M., & Vinci, S. L. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e10288 · Cited by 3
“Recent studies highlighted that EVT reperfusion in AIS, even up to 24 h from symptom onset, has a high level of evidence in reducing both mortality and morbidity [3, 5, 6].”
BackgroundKim, B. J., Zhu, K., Qiu, W., Singh, N., McDonough, R. V., Cimflová, P., Bala, F., Kim, J., Kim, Y. S., Bae, H., et al. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1201223 · Cited by 3
“Excluded patients were those with (1) no DWI lesion (n = 64); (2) DWI lesion volume smaller than 2 mL (n = 154); (3) significant motion artifacts (n = 5), irreparable misregistration (n = 6) and severe beam hardening artifacts (n = 2).”
BackgroundMethodInfluentialSelf-citationPark, Y. K., Yoon, B.-H., Won, Y. D., Kim, J. H., & Kang, H. I. (2023) · Journal of Korean Neurosurgical Society · doi:10.3340/jkns.2023.0133 · Cited by 3
“The government strongly recommends the administration of IVT within 1 hour from emergency room arrival, and this is used as an important indicator for the evaluation of hospital quality 12) .”
Self-citationChoi, S., Lee, E.-H., Sheen, J. J., Kim, M. S., Kim, Y. W., Won, Y.-D., Lee, S. B., & Lee, T. (2021) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2021.106797 · Cited by 3
Eun, M., Park, J., Cho, B., Cho, K., & Yu, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10204719 · Cited by 2
Lee, Y., Park, D., Kim, B. H., Lee, S.-E., & Lee, J. W. (2020) · Journal of Electrodiagnosis and Neuromuscular Diseases · doi:10.18214/jend.2020.00108 · Cited by 2
Self-citationPark, M., Park, J., Joo, A., Chang, Y., & Song, T. (2022) · PeerJ · doi:10.7717/peerj.13327 · Cited by 2
“We evaluated all patients using our institution’s standard stroke evaluation protocol based on the American Heart Association and Korean clinical practice guidelines (Jauch et al., 2013; Ko et al., 2019), which included routine blood tests (blood glucose level at admission, total cholesterol, low-density lipoprotein,…”
MethodKim, H. J., Park, M., Yoo, J., Kim, Y. D., Park, H., Kim, B. M., Bang, O. Y., Kim, H. C., Han, E., Kim, D. J., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195599 · Cited by 2
Self-citationNationwide questionnaire survey on neuroimaging strategy for acute ischemic stroke in Japan
Okada, T., Inoue, M., Yamagami, H., Tanaka, K., Shiozawa, M., Sonoda, K., Ikenouchi, H., Fukuda, T., Satow, T., Ihara, M., et al. (2020) · Nosotchu · doi:10.3995/jstroke.10781 · Cited by 2
Yun, J., Park, H., Nam, H. S., Heo, J. H., & Kim, Y. D. (2025) · BMC Neurology · doi:10.1186/s12883-025-04549-y · Cited by 1
“National clinical practice guidelines recommend that each center develop its own imaging pathway for identifying target mismatch in late-presenting patients[7], reflecting variation in local infrastructure and resource availability rather than a standardized national protocol.”
Self-citationPoorer Outcomes With Blood Pressure Lowering in Severe White Matter Disease After Thrombectomy
Baik, M., Jung, J. W., Lee, H., Heo, J., Kim, Y. D., Joo, H., Kim, B. M., Kim, D., Shin, N., Cho, B., et al. (2026) · Stroke · doi:10.1161/strokeaha.125.053191 · Cited by 1
Self-citationMENA-adapted guidelines for acute ischemic stroke management: a regional approach to global evidence
Mansour, O. Y., Ezzeldin, M., Nour, M., Hassan, A., Zaidi, S. F., Jumaa, M. A., Aladham, F., Alnaami, I., Al-Jehani, H. M., Alshamy, A., et al. (2026) · Neurological Research · doi:10.1080/01616412.2026.2637833 · Cited by 1
Reperfusion therapy in acute ischemic stroke
Lee, S., & Lee, J.-H. (2022) · Journal of Korean Medical Association · doi:10.5124/jkma.2022.65.7.430 · Cited by 1
Kou, W., Wang, X., Yang, J.-S., Qiao, N., Nie, X.-H., Yu, A.-M., Song, A., & Xue, Q. (2022) · World Journal of Clinical Cases · doi:10.12998/wjcc.v10.i28.10077 · Cited by 1
Ko, Y., Kim, B. J., Kim, Y., Park, J., Kang, K., Kim, J. G., Cha, J., Park, T. H., Lee, K. B., Lee, J., et al. (2024) · Journal of Korean Medical Science · doi:10.3346/jkms.2025.40.e49 · Cited by 1
Self-citationMsigwa, S. S. (2021) · Rwanda Journal of Medicine and Health Sciences · doi:10.4314/rjmhs.v4i3.12 · Cited by 1
Kim, Y., Kim, M., Kim, J., & Song, T. (2022) · medRxiv · doi:10.1101/2022.08.16.22278857 · Cited by 1
Self-citationHan, S., Choi, J. H., So, H. S., Choi, H., Jeon, H. J., Kim, J., & Kim, K. (2021) · 신경정신의학 · doi:10.4306/jknpa.2021.60.4.346
Self-citationLee, S., Lee, T.-K., & Moon, J. E. (2022) · Journal of Neurocritical Care · doi:10.18700/jnc.220054
Ok, T., Yoon, P. H., Kim, G. S., & Seo, K. (2022) · Journal of Korean Medical Science · doi:10.3346/jkms.2023.38.e14
Eun, M., Choi, W., Hwang, Y., Kim, K. H., & Kim, Y. W. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1647008
Acute Ischemic Stroke Treatment
Zedde, M., Arsovska, A. A., & Pascarella, R. (2026) · Springer eBooks · doi:10.1007/978-3-031-82232-2_47
Jung, J. W., Kim, Y. D., Heo, J., Lee, H., Kim, B. M., Kim, D. J., Shin, N.-Y., Joo, H., Yu, S., Ahn, S. H., et al. (2026) · Stroke · doi:10.1161/strokeaha.126.055632
Self-citation
Metadata
- Authors
- Ko, S.-B., Park, H.-K., Kim, B. M., Heo, J. H., Rha, J.-H., Kwon, S. U., Kim, J. S., Lee, B.-C., Suh, S. H., Jung, C., Jeong, H. W., Kang, D.-H., Bae, H.-J., Yoon, B.-W., & Hong, K.-S.
- Affiliations
- Seoul National University (KR)
- Inje University Ilsan Paik Hospital (KR)
- Yonsei University (KR)
- Inha University (KR)
- Asan Medical Center (KR)
- Hallym University Sacred Heart Hospital (KR)
- Inje University Busan Paik Hospital (KR)
- Kyungpook National University (KR)
- Corresponding author
- Hong, Keun-Sik
- ORCID
- Venue
- Journal of Stroke
- Publisher
- Korean Stroke Society
- Published
- 2019-05-31
- Volume
- 21
- Issue
- 2
- Pages
- 231-240
- ISSN
- 2287-6391 (ISSN-L)
- 2287-6405
- PMC
- PMC6549067
- OpenAlex
- W2936786637
- Cited by
- 63
- References
- 37
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 19 · 2021: 10 · 2020: 14
- FWCI
- 8.18
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Journal of Stroke (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Clinical Neurology › Intracranial Aneurysms: Treatment and Complications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- acute ischemic stroke, large vessel occlusion, extended time window, mechanical thrombectomy
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