Endovascular treatment for the acute ischemic stroke: the past and the future

2018 ◽  
Vol 3 ◽  
pp. 15-15
Author(s):  
Rui Liu ◽  
Wei Li ◽  
Erwin Stolz
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
The Past ◽  
The Future

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 Therapeutic Advancements in the Endovascular Management of Acute Ischemic Stroke

2021 ◽  
Author(s):  
Mahmoud H. Mohammaden ◽  
Diogo C. Haussen ◽  
Raul G. Nogueira
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Randomized Trials ◽  
Randomized Clinical Trials ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
The Past ◽  
Technological Advances ◽  
Device Technology

Abstract Stroke is the major cause of disability and the second leading cause of death worldwide. Acute ischemic stroke is responsible for ∼85% of all strokes, with 24% to 46% attributable to large‐vessel occlusion, which are typically associated with worse outcomes. Although the initial efforts to develop endovascular treatment for acute ischemic stroke took place over 6 decades ago, critical gaps in device technology and treatment selection existed, resulting in 3 failed randomized clinical trials published in 2013. Fortunately, devices and techniques have dramatically evolved over the past decade, leading to significant improvements in the safety, speed, and completeness of reperfusion. Since 2015, a total of 9 randomized trials have consistently demonstrated an overwhelming benefit to endovascular reperfusion. In this article, we will review the evolution of endovascular treatment for acute ischemic stroke, including the technical and technological advances as well as the perspectives in terms of patient selection and procedural and clinical outcomes of the landmark past and recent trials.

Endovascular Treatment in Acute Ischemic Stroke - Three Years Clinical Experience

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
S. Andonova ◽  
E. Kalevska ◽  
Ch. Bachvarov ◽  
Tz. Dimitrova ◽  
M. Petkova ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Clinical Experience

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

scholarly journals Outcome of endovascular treatment within and beyond 6 h without perfusion software

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhen Jing ◽  
Hao Li ◽  
Shengming Huang ◽  
Min Guan ◽  
Yongxin Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Symptom Onset ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Group A ◽  
Group B

AbstractEndovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.

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