scholarly journals The current situation and prospects of revascularization therapy for acute ischemic stroke in the world and Japan

Nosotchu ◽  
2010 ◽  
Vol 32 (6) ◽  
pp. 694-696
Author(s):  
Kazuo Minematsu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Situation ◽  
The World ◽  
Revascularization Therapy

Abstract WP12: Impact of the Introduction of Endovascular Treatment on Acute Ischemic Stroke Therapy in a Rural Broad Region in Japan

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Taichiro Imahori
Keyword(s):  
Ischemic Stroke ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Group 2 ◽  
Revascularization Therapy ◽  
Standard Medical Treatment ◽  
Iv Tpa ◽  
Broad Region ◽  
Group 1

Background: Endovascular treatment (EVT) has been proven to be effective for selected patients with acute ischemic stroke (AIS). We evaluated the effect of the introduction of EVT on outcome of AIS therapy in a rural broad region in Japan, covering an area within a radius of 80km by air ambulance. Methods: Between January 2014 and July 2016, 210 consecutive patients with acute large vessel occlusion (189 patients in the anterior circulation and 21 in the posterior circulation) admitted to our institute were analyzed. EVT was introduced into the AIS therapy at our institute in April 2015. We compared the outcome of the patients during the period before (group 1: standard medical treatment including intravenous [IV] tPA) and after (group 2: standard medical treatment including IV tPA with or without EVT) the introduction of EVT. Results: In the group 1, all 87 patients (median age, 81 years; NIHSS, 20; ASPECTS, 8; onset to door, 237min; IV tPA 24%) were treated medically (Table 1). In the group 2, among 123 patients (age, 82 years; NIHSS, 20; ASPECTS, 8; onset to door, 149min; IV tPA 16%), 47 patients were treated medically, and the remaining 76 patients underwent EVT (TICI 2b or 3, 84%). Although the median transfer distance increased (23km in the group 1 vs 30km in the group 2, p=0.028), the median time from call to admission was equivalent (42min vs 43min, p=0.93) because of the increase in the proportion of the helicopter transfer (30% vs 41%, p=0.14). The rates of patients who underwent revascularization therapy with IV tPA or EVT (24% vs 66%, p<0.001) and good outcome (mRS 0 to 2) at discharge (11% vs 24%, p=0.021) increased significantly after the introduction of EVT approach. Conclusions: Our study showed that the introduction of EVT improved the outcome of the AIS therapy with significant increase in the number of patients receiving revascularization therapy. EVT in collaboration with air ambulance might expand the target area for revascularization therapy in a rural broad region.

Overview of endovascular thrombectomy accessibility gap for acute ischemic stroke in Asia: A multi-national survey

2019 ◽  
Vol 15 (5) ◽  
pp. 516-520 ◽  
Author(s):  
Anderson Chun On Tsang ◽  
I-Hsiao Yang ◽  
Emanuele Orru ◽  
Quang-Anh Nguyen ◽  
Roselyn V Pamatmat ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Income ◽  
Disease Burden ◽  
Intravenous Thrombolysis ◽  
Low Income Countries ◽  
Endovascular Thrombectomy ◽  
Stroke Units ◽  
Revascularization Therapy ◽  
High Treatment

Endovascular thrombectomy revolutionized the treatment of acute ischemic stroke. Nevertheless, access to endovascular thrombectomy is limited in many parts of the world. Asia holds 60% of the world’s population and its countries carry some of the highest stroke disease burden. To understand the availability of endovascular thrombectomy and intravenous thrombolysis in this region, we interviewed stroke neurologists and neuro-interventionists of 19 Asian countries, and found a large disparity in access to endovascular thrombectomy and intravenous thrombolysis between high- and low-income countries. Lack of neuro-interventionists, comprehensive stroke units, stroke triage systems and high treatment cost are the major obstacles to wider accessibility of endovascular thrombectomy, especially among developing countries. The potential solutions to provide equitable access to stroke revascularization therapy are discussed.

scholarly journals Mortality after large artery occlusion acute ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rahul R. Karamchandani ◽  
Jeremy B. Rhoten ◽  
Dale Strong ◽  
Brenda Chang ◽  
Andrew W. Asimos
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Artery Occlusion ◽  
Large Artery ◽  
Multivariable Logistic Regression Model ◽  
Stroke Registry ◽  
Social Security Death Index ◽  
Revascularization Therapy

AbstractDespite randomized trials showing a functional outcome benefit in favor of endovascular therapy (EVT), large artery occlusion acute ischemic stroke is associated with high mortality. We performed a retrospective analysis from a prospectively collected code stroke registry and included patients presenting between November 2016 and April 2019 with internal carotid artery and/or proximal middle cerebral artery occlusions. Ninety-day mortality status from registry follow-up was corroborated with the Social Security Death Index. A multivariable logistic regression model was fitted to determine demographic and clinical characteristics associated with 90-day mortality. Among 764 patients, mortality rate was 26%. Increasing age (per 10 years, OR 1.48, 95% CI 1.25–1.76; p < 0.0001), higher presenting NIHSS (per 1 point, OR 1.05, 95% CI 1.01–1.09, p = 0.01), and higher discharge modified Rankin Score (per 1 point, OR 4.27, 95% CI 3.25–5.59, p < 0.0001) were independently associated with higher odds of mortality. Good revascularization therapy, compared to no EVT, was independently associated with a survival benefit (OR 0.61, 95% CI 0.35–1.00, p = 0.048). We identified factors independently associated with mortality in a highly lethal form of stroke which can be used in clinical decision-making, prognostication, and in planning future studies.

Abstract W P2: Intra-arterial Contrasted Cone-beam CT Assessment of Occluded Distal Vessels in Acute Ischemic Stroke Patients with Major Vessel Occlusion

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tatsuo Amano ◽  
Masayuki Sato ◽  
Kentaro Mori ◽  
Yuji Matsumaru ◽  
Yusuke Hamada
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Strategy ◽  
Cone Beam Ct ◽  
Ascending Aorta ◽  
Cone Beam ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Major Vessel ◽  
Revascularization Therapy

Background and Purpose: Identifying the information of occluded distal vessels is quite important for making a suitable selection of treatment strategy and devices in endovascular revascularization therapy (EVT) for acute ischemic stroke patients. It has been demonstrated that intra-venous cone-beam CT (IV-CBCT) is able to visualize distally of the occluded vessels. In this study, intra-arterial contrasted high-resolution cone-beam CT from ascending aorta (Ao-CBCT) was newly introduced for the visualization of occluded distal vessels and its clinical values were assessed Methods: Acute ischemic stroke patients with major vessel occlusion planed EVT were evaluated. Adaption of EVT was decided by using MRI/MRA assessment in advance. In endovascular procedure, digital subtraction angiography (DSA) and Ao-CBCT were performed to evaluate occluded site, collaterals and occluded distal vessels with local anesthesia. Ao-CBCT images were acquired in 20 seconds rotational scan. Contrast medium was injected from ascending aorta with 1mL/s for a total of 30 seconds by use of a 4F or 6F catheter and an imaging delay of 10 seconds. We assessed the image quality of Ao-CBCT and compared in the visualization of occluded distal vessels among MRA, DSA and Ao-CBCT. Results: We analyzed 14 patients (mean age, 66 years. 3 female patients), respectively. Stroke subtypes were cardiogenic (n=6), atherothrombotic (n=5) and others/unknown (n=3). Occluded site were MCA M1 (n=8), MCA M2 (n=2), ICA (n=2), MCA M4 (n=1) and BA (n=1). All obtained Ao-CBCT images could evaluate occlusion distal vessels successfully and 11 images (79%) were excellent. In all cases, Ao-CBCT images could depict occluded distal vessels more detailed than MRA and DSA. Conclusions: Ao-CBCT is an efficient method to obtain the detailed information of occluded vessels compared with conventional examination methods. It requires less contrast agent compared to IV-CBCT, while maintaining enough information to determine treatment strategy.

scholarly journals Free Radical Damage in Ischemia-Reperfusion Injury: An Obstacle in Acute Ischemic Stroke after Revascularization Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-17 ◽  
Author(s):  
Ming-Shuo Sun ◽  
Hang Jin ◽  
Xin Sun ◽  
Shuo Huang ◽  
Fu-Liang Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Free Radical ◽  
Acute Ischemic Stroke ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Free Radical Damage ◽  
Revascularization Therapy ◽  
Radical Damage ◽  
Neuroprotective Therapies

Acute ischemic stroke is a common cause of morbidity and mortality worldwide. Thrombolysis with recombinant tissue plasminogen activator and endovascular thrombectomy are the main revascularization therapies for acute ischemic stroke. However, ischemia-reperfusion injury after revascularization therapy can result in worsening outcomes. Among all possible pathological mechanisms of ischemia-reperfusion injury, free radical damage (mainly oxidative/nitrosative stress injury) has been found to play a key role in the process. Free radicals lead to protein dysfunction, DNA damage, and lipid peroxidation, resulting in cell death. Additionally, free radical damage has a strong connection with inducing hemorrhagic transformation and cerebral edema, which are the major complications of revascularization therapy, and mainly influencing neurological outcomes due to the disruption of the blood-brain barrier. In order to get a better clinical prognosis, more and more studies focus on the pharmaceutical and nonpharmaceutical neuroprotective therapies against free radical damage. This review discusses the pathological mechanisms of free radicals in ischemia-reperfusion injury and adjunctive neuroprotective therapies combined with revascularization therapy against free radical damage.

scholarly journals Therapeutic-induced hypertension in patients with noncardioembolic acute stroke

Neurology ◽  
2019 ◽  
Vol 93 (21) ◽  
pp. e1955-e1963 ◽  
Author(s):  
Oh Young Bang ◽  
Jong-Won Chung ◽  
Soo-Kyoung Kim ◽  
Suk Jae Kim ◽  
Mi Ji Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Intervention Group ◽  
Functional Independence ◽  
Stroke Severity ◽  
Class Iii ◽  
Induced Hypertension ◽  
Safety Outcomes ◽  
Revascularization Therapy

ObjectiveTo evaluate the safety and efficacy of induced hypertension in patients with acute ischemic stroke.MethodsIn this multicenter randomized clinical trial, patients with acute noncardioembolic ischemic stroke within 24 hours of onset who were ineligible for revascularization therapy and those with progressive stroke during hospitalization were randomly assigned (1:1) to the control and intervention groups. In the intervention group, phenylephrine was administered intravenously to increase systolic blood pressure (SBP) up to 200 mm Hg. The primary efficacy endpoint was early neurologic improvement (reduction in NIH Stroke Scale [NIHSS] score of ≥2 points during the first 7 days). The secondary efficacy endpoint was a modified Rankin Scale score of 0 to 2 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage/edema, myocardial infarction, and death.ResultsIn the modified intention-to-treat analyses, 76 and 77 patients were included in the intervention and control groups, respectively. After adjustment for age and initial stroke severity, induced hypertension increased the occurrence of the primary (odds ratio 2.49, 95% confidence interval [CI] 1.25–4.96, p = 0.010) and secondary (odds ratio 2.97, 95% CI 1.32–6.68, p = 0.009) efficacy endpoints. Sixty-seven (88.2%) patients of the intervention group exhibited improvements in NIHSS scores of ≥2 points during induced hypertension (mean SBP 179·7 ± 19.1 mm Hg). Safety outcomes did not significantly differ between groups.ConclusionAmong patients with noncardioembolic stroke who were ineligible for revascularization therapy and those with progressive stroke, phenylephrine-induced hypertension was safe and resulted in early neurologic improvement and long-term functional independence.ClinicalTrials.gov identifierNCT01600235.Classification of evidenceThis study provides Class III evidence that for patients with acute ischemic stroke, therapeutic-induced hypertension increases the probability of early neurologic improvement.

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