scholarly journals The Quest for Arterial Recanalization in Acute Ischemic Stroke-The Past, Present and the Future

2013 ◽  
Author(s):  
Yeo
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The Past ◽  
The Future ◽  
Arterial Recanalization

Abstract 74: Early Arterial Recanalization After Intra-venous Tissue-Plasminogen-Activator Treatment in the Interventional Management of Stroke-3 Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ruediger Von Kummer ◽  
Andrew M Demchuk ◽  
Lydia D Foster ◽  
Bernard Yan ◽  
Wouter J Schonewille ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Arterial Occlusion ◽  
Posterior Circulation ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Tissue Plasminogen ◽  
Arterial Recanalization

Background: Data on arterial recanalization after IV t-PA treatment are rare. IMS-3 allows the study of variables affecting arterial recanalization after IV t-PA in acute ischemic stroke patients with CTA-proved major artery occlusions. Methods: Of 656 acute ischemic stroke patients in IMS-3, 306 were examined with baseline CTA and randomized either to IV t-PA (N=95) or to IV t-PA followed by digital subtraction angiography (DSA) and endovascular therapy (EVT) (N=211). Comparison of baseline CTA to DSA within 5 hours of stroke onset assessed early arterial recanalization after IV t-PA. A central core lab categorized DSA vessel occlusion as “no, partial, or complete”. We studied the association between arterial occlusion sites on baseline CTA with early recanalization for the endovascular group and analyzed its impact on clinical outcome at 90 days. Results: In the EVT group, 22 patients (10.4%) had no CTA intracranial occlusions, but 1 extracranial occlusion; 42 patients (19.9%) had occlusions of intracranial internal carotid artery (ic-ICA); 10 patients (4.7%) had tandem occlusions of the cervical ICA and middle cerebral artery (MCA); 95 patients (45.0%) had MCA-trunk (M1) occlusions, 33 patients (15.6%) had M2 occlusions, 3 patients (1.4%) had M3/4 occlusions, and 6 patients (2.8%) occlusions within posterior circulation. Partial or complete recanalization occurred in 28.6% of patients before DSA and was marginally associated with occlusion site (p=0.0525) (8 patients (19.0%) with ic-ICA occlusion, 0 patients with tandem ICA/MCA occlusions, 34 patients (35.8%) with M1 occlusions, 11 patients (33.3%) with M2 occlusions, 0 patients with M3/4 occlusions, and 1 patient (16.7%) with occlusion within posterior circulation). Three CTA negative patients had intracranial occlusions on DSA. Thirty-two patients (59.3%) with early recanalization achieved mRS of 0-2 at 90 days compared to 51 patients (38.4%) without early recanalization (p=0.0099). There was no relationship between early recanalization and time to IV t-PA or mean t-PA dose. Conclusion: Before EVT, IV rt-PA may facilitate arterial recanalization and better clinical outcome in about one third of patients.

Stent retrievers: the future treatment of choice for endovascular recanalization in acute ischemic stroke

2013 ◽  
Vol 5 (2) ◽  
pp. 145-147
Author(s):  
Tareq Kass-Hout ◽  
Omar Kass-Hout ◽  
Rishi Gupta ◽  
Raul G Nogueira
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Future Treatment ◽  
Endovascular Recanalization ◽  
The Future ◽  
Stent Retrievers

scholarly journals Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kenan Alkhalili ◽  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
David Hasan ◽  
Robert M. Starke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Treatment Strategies ◽  
Endovascular Intervention ◽  
Treatment Modalities ◽  
Efficacy And Safety ◽  
The Past ◽  
Endovascular Approach

Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

scholarly journals Endovascular Treatment for Acute Ischemic Stroke: Updates and Future Implications

2015 ◽  
Vol 4 (1-2) ◽  
pp. 43-47 ◽  
Author(s):  
Jie Gao ◽  
Qiliang Dai ◽  
Xinfeng Liu
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Intravenous Thrombolysis ◽  
Professional Organizations ◽  
Infarct Core ◽  
The Past ◽  
Proximal Occlusion ◽  
Positive Results

Stroke constitutes the primary cause of acquired disability in adults and is a second leading cause of death worldwide. The low recanalization rate after intravenous thrombolysis calls for an alternate therapy for acute ischemic stroke. The methodology for endovascular treatment has evolved greatly over the past two decades. The past 6 months have seen great progress in this area, with several randomized clinical trials all proving the efficacy and safety of endovascular treatment. Three key factors are important for good functional outcome after endovascular treatment: fast imaging to prove proximal occlusion and to exclude large infarct core, using mainly the stent retriever thrombectomy devices and establishing an efficient workflow to achieve fast reperfusion. Although positive results of RCTs are encouraging and bring what is urgently needed in the field, transforming these positive results into clinical practice will be both a challenge and opportunity of the next 5 years. It will need hard work, leadership and cooperation of all members involved in the chain of treating a stroke patient. In the wake of these positive trials, hospitals and professional organizations are working together to save every minute when fighting against this devastating disease.

scholarly journals Endovascular stroke intervention in young patients with large vessel occlusions

2014 ◽  
Vol 36 (1) ◽  
pp. E6 ◽  
Author(s):  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Robert M. Starke ◽  
David Hasan ◽  
Nimrita Sidhu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Young Patients ◽  
Intravenous Thrombolysis ◽  
Endovascular Intervention ◽  
Large Vessel ◽  
Arterial Recanalization ◽  
The Mean

Object Endovascular therapy has become a widely used method for achieving arterial recanalization in patients who are ineligible for intravenous thrombolysis or those in whom it is unsuccessful. Young stroke patients with large vessel occlusions may particularly benefit from endovascular intervention. This study aims to assess the authors' experience with the use of modern endovascular techniques to treat young patients (≤ 55 years old) with acute ischemic stroke and large vessel occlusions. Methods Young patients (≤ 55 years old) undergoing endovascular intervention for acute ischemic stroke at the authors' institution were identified from a prospectively maintained database. Only those patients with a confirmed large vessel occlusion were included. Modified Rankin Scale (mRS) scores were determined at 90 days during a follow-up visit. A multivariate analysis was performed to determine predictors of outcome (mRS score 0–2). Results A total of 45 patients met the inclusion criteria. The mean age of the patients in this series was 45 ± 9.6 years. The mean admission NIH Stroke Scale score was 14.1 ± 5 (median 13.5). Mechanical thrombectomy was performed using the Solitaire FR device in 13 (29%) patients and the Merci/Penumbra systems in 32 (71%) patients. The rate of successful recanalization (Thrombolysis In Myocardial Infarction [TIMI] scale Grade II–III) was 93% (42/45). Only 1 patient (2.2%) had a symptomatic intracranial hemorrhage following intervention. One patient (2.2%) sustained a vessel perforation intraoperatively. The rate of 90-day favorable outcome (mRS score 0–2) was 77.5% and the rate of 90-day satisfactory outcome (mRS score 0–3) was 90%. The 90-day mortality rate was 7.5%. In multivariate analysis, postprocedure TIMI grade was the only statistically significant independent predictor of 90-day outcome (OR 3.3, 95% CI 1.01–1.19; p = 0.05). Conclusions The results of this study demonstrate that endovascular therapy provides remarkably high rates of arterial recanalization and favorable outcomes in young patients with acute ischemic stroke and large vessel occlusions. These findings support aggressive interventional strategies in these patients. Randomized, controlled trials reflecting modern acute ischemic stroke treatment will be needed to confirm the findings of this study.

scholarly journals INTRA-ARTERIAL THROMBECTOMY IN THE MANAGEMENT OF ACUTE ISCHEMIC STROKE: EVIDENTIARY ANALYSIS OVER THE PAST TWO YEARS

2017 ◽  
Vol 37 (2) ◽  
pp. 91-96
Author(s):  
Gabriel Veloso Cunha ◽  
Guilherme da Silva Fernandes ◽  
Ettore Mendes Azenha ◽  
Talyta Cortez Grippe
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The Past

scholarly journals Reflection on the Past, Present, and Future of Thrombolytic Therapy for Acute Ischemic Stroke

Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S170-S177
Author(s):  
Stacie L. Demel ◽  
Robert Stanton ◽  
Yasmin N. Aziz ◽  
Opeolu Adeoye ◽  
Pooja Khatri
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Critical Role ◽  
Recombinant Tissue Plasminogen Activator ◽  
Initial Time ◽  
Stroke Treatment ◽  
The Past ◽  
Therapeutic Landscape

More than 25 years have passed since the US Food and Drug Administration approved IV recombinant tissue plasminogen activator (alteplase) for the treatment of acute ischemic stroke. This landmark decision brought a previously untreatable disease into a new therapeutic landscape, providing inspiration for clinicians and hope to patients. Since that time, the use of alteplase in the clinical setting has become standard of care, continually improving with quality measures such as door-to-needle times and other metrics of specialized stroke unit care. The past decade has seen more widespread use of alteplase in the prehospital setting with mobile stroke units and telestroke and beyond initial time windows via the use of CT perfusion or MRI. Simultaneously, the position of alteplase is being challenged by new lytics and by the concept of its bypass altogether in the era of endovascular therapy. We provide an overview of alteplase, including its earliest trials and how they have shaped the current therapeutic landscape of ischemic stroke treatment, and touch on new frontiers for thrombolytic therapy. We highlight the critical role of thrombolytic therapy in the past, present, and future of ischemic stroke care.

scholarly journals Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion

Cureus ◽  
2019 ◽  
Author(s):  
Taylor S Harmon ◽  
Paul C Hulsberg ◽  
Joseph R McFarland ◽  
Victoria V Villescas ◽  
Jerry Matteo
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Management ◽  
The Future
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