scholarly journals New Advances in Acute Ischemic Stroke Management: Review Article

2020 ◽  
Vol 7 (2) ◽  
pp. 55-60
Author(s):  
Hossein Aghamiri ◽  
Sepideh Paybast ◽  
Behnam Safarpour Lima ◽  
Behnam Mansoori
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Web Of Science ◽  
State Of The Art ◽  
Data Extraction ◽  
Treatment Strategies ◽  
Recent Advances ◽  
The Brain ◽  
Arterial Thrombolysis

Cerebrovascular disease is the second cause of death and the sixth cause of morbidity worldwide, which will rise to fourth place by 2020. The treatment strategies for acute ischemic stroke (AIS) divided into two groups, including intravenous or intra-arterial thrombolysis and mechanical thrombectomy. Regarding growing development in the realm of diagnosis and treatment of stroke through state-of-the-art approaches, including emergent thrombectomy, there are new opportunities for investigation in this area. This is while a rough rate of 85% for strokes is occupied by, and the remained is hemorrhagic. Hence, the present study aimed to review recent advances in AIS with a focus on emergent thrombectomy. Here, we first provided the relevant history, and then the recent advances were discussed. The library data collection method was employed so that such databases as Web of Science, PubMed, and Science Direct used for data extraction. The evidence confirms the importance of emergent thrombectomy as all believe the famous statement "time is the brain." However, further investigations are required to find more strong evidence accordingly.

scholarly journals Treatment Strategies for Tandem Occlusions in Acute Ischemic Stroke

2020 ◽  
Vol 37 (02) ◽  
pp. 207-213
Author(s):  
Joseph J. Gemmete ◽  
Zachary Wilseck ◽  
Aditya S. Pandey ◽  
Neeraj Chaudhary
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Carotid Revascularization ◽  
Tandem Occlusion ◽  
Coil Occlusion ◽  
Optimal Treatment Strategy

AbstractThere is no consensus for the treatment of a tandem occlusion (TO) in a patient presenting with an acute ischemic stroke. In this review article, we will focus on the controversial treatment strategies for TOs. First, we will discuss treatment options including retrograde, antegrade, and delayed approaches. Second, the role of carotid stent placement versus balloon angioplasty for the extracranial occlusion will be presented. Third, anticoagulation and antiplatelet regimens for the treatment TOs published in the literature will be reviewed. Finally, we will discuss whether there is a role for coil occlusion of the cervical carotid artery or whether staged carotid revascularization days after mechanical thrombectomy of the intracranial occlusion maybe appropriate. The optimal treatment strategy of TO has not been established and further larger trials need to be performed to answer the question.

scholarly journals Recent guidelined for the early endovascular management of patients with acute ischemic stroke and practical aspects of their implementation

2018 ◽  
Vol 24 (2) ◽  
pp. 20-29
Author(s):  
А.М. Netliukh ◽  
V.М. Shevaga ◽  
A.V. Payenok ◽  
В.M. Salo ◽  
О.Ya. Kobyletskyi
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Cerebral Ischaemia ◽  
Mechanical Thrombectomy ◽  
Radiology Department ◽  
Stroke Treatment ◽  
Stent Retrievers ◽  
Reperfusion Rate ◽  
Arterial Thrombolysis

Objective — to estimate safety and effectiveness of intra-arterial treatment for acute ischemic stroke in the interventional radiology department of multiprofile hospital. Materials and methods. Urgent endovascular treatment was applied at 15 patients with acute ischemic stroke in carotid circulation during 2015–2017. Mechanical intra-arterial therapy with thrombectomy by stent-retrievers and thromboaspiration was used at accordingly six and two recent cases (during 2017); in 7 cases intra-arterial thrombolysis was the treatment option (2015–2016). Results. The article consist brief review of literature about acute ischemic stroke treatment and discussion concerning results of treatment of selected patients. Mechanical thrombectomy or thromboaspiration were effective in 75.0 % of cases with good recanalization rate opposite to 42.9 % at 7 patients treated by either intra-arterial or bridging thrombolysis with rt-PA. Unexpected technical failures of mechanical thrombectomy regarding recent clinical guidelines for ischemic stroke management following are discussed on example of 2 clinical cases. Conclusions. Endovascular treatment of ischemic stroke has a high safety and well-known efficacy. It became evident at our patients that following current management guidelines for thrombectomy with stent-retrievers or thromboaspiration after thrombotic occlusions of extracranial and proximal segments of intracranial arteries allowed attaining in 2017 reperfusion rate 2b/3 Modified Treatment in Cerebral Ischaemia Scale in majority of cases. Intra-arterial thrombolysis contributed to the reperfusion rate 2b/3 on the Modified Treatment in Cerebral Ischaemia scale just in 42.9 % of cases, which indicates its lower effectiveness.

scholarly journals Integrated treatment of stroke

2015 ◽  
pp. 4-27
Author(s):  
N.K. Svyrydova ◽  
A.S. Lubenets ◽  
A.V. Popov ◽  
N.P. Pavlyuk ◽  
K.M. Usovych ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Strategies ◽  
Medical Problem ◽  
Integrated Treatment ◽  
Premature Deaths ◽  
Stroke Disability ◽  
Complex Disability ◽  
Clinical Pictures ◽  
The Brain

Stroke is the second single most common cause of death in the world. Almost 1 in 8 (11.9%) deaths worldwide is caused by stroke. Disability and premature deaths caused by stroke is set to double worldwide by 2030. Acute ischemic stroke (AIS) is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Among the major risk factors for stroke are most common: hypertension, diabetes, atrial fibrillation, patent foramen ovale, high cholesterol, sickle cell anemia, smoking, alcohol. Strokes can be divided into 2 types: hemorrhagic or ischemic. Each of these categories can be divided into subtypes that have somewhat different causes, clinical pictures, clinical courses, outcomes, and treatment strategies. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery. Stroke is not only a medical problem, but also social and economic. Stroke is the largest cause of complex disability half of all stroke survivors are left with a disability. The greatest phase of recovery is usually within the first days and weeks after stroke, therefore, treatment and rehabilitation should be carried out from the first minute confirmation of the diagnosis.

scholarly journals A novel clinical nomogram for predicting 3-month unfavorable outcomes of stroke patients treated with mechanical thrombectomy

2021 ◽  
Author(s):  
Xiao-Guang Zhang ◽  
Jia-Hui Wang ◽  
Wen-Hao Yang ◽  
Xiao-Qiong Zhu ◽  
Jie Xue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Characteristic Curve ◽  
Treatment Strategies ◽  
Stroke Patients ◽  
Bridging Therapy ◽  
Vessel Occlusion ◽  
Discriminative Performance ◽  
Preoperative Creatinine

Abstract Background: Mechanical thrombectomy (MT) is an effective treatment for large-vessel occlusion in acute ischemic stroke, however, only some revascularized patients have a good prognosis. For stroke patients undergoing MT, predicting the risk of unfavorable outcomes and adjusting the treatment strategies accordingly can greatly improve prognosis. Therefore, we aimed to develop and validate a nomogram that can predict 3-month unfavorable outcomes for individual stroke patient treated with MT. Methods: We analyzed 238 patients with acute ischemic stroke who underwent MT from January 2018 to October 2020. The primary outcome was a 3-month unfavorable outcome, assessed using the modified Rankin Scale (mRS), 3-6. A nomogram was generated based on a multivariable logistic model. We used the area under the receiver-operating characteristic curve to evaluate the discriminative performance and used the calibration curve and Spiegelhalter’s Z-test to assess the calibration performance of the risk prediction model. Results: After multivariable logistic regression, six variables (gender, bridging therapy, postoperative mTICI, stroke-associated pneumonia, preoperative creatinine and Na) remained independent predictors of 3-month unfavorable outcomes in stroke patients treated with MT, thus forming a nomogram. The area under the nomogram curve was 0.848 with good calibration performance (P = 0.946 for the Spiegelhalter’s Z-test). Conclusions: A novel nomogram consisting of gender, bridging therapy, postoperative mTICI, stroke-associated pneumonia, preoperative creatinine and Na can predict the 3-month unfavorable outcomes in stroke patients treated with MT.

scholarly journals Mechanical Thrombectomy for Acute Ischemic Stroke in Nepal

2021 ◽  
Vol 1 (1) ◽  
pp. 35-37
Author(s):  
Pravesh Rajbhandari ◽  
Saujanya Rajbhandari ◽  
Anish Neupane ◽  
Pritam Gurung
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Treatment Strategies ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Imaging ◽  
Number Of Patients ◽  
Causes Of Mortality

Stroke is one of the leading causes of mortality and the number one cause of dependency in the world. Endovascular therapy has emerged as promising treatment strategy in the patient with acute ischemic stroke due to large vessel occlusion in anterior circulation. Moreover, the time window for mechanical thrombectomy have also been expanded based on the recent DAWN and DEFUSE-3 trial. It is evident that this trend could dramatically increase the number of potential patients for the treatment. Moreover, advancement in stroke imaging have guided physicians to make wisest decision in identifying suitable patient who can get benefit from the recent treatment strategies. The stroke management is evolving and continues to improve, making better outcome of the patient possible. In context of our country Nepal, it is also necessary to educate and aware medical staffs including physicians, nurses, laboratory/ radiology personnel to design a proper acute stroke team to deliver successful therapy which will eventually make a sound impact in a large number of patients with stroke. Herein, we report a case of a 69-year-old gentleman who presented with right middle cerebral artery territory infarction within 3hours of onset of symptoms and underwent mechanical thrombectomy as a part of the treatment.

scholarly journals Mechanical Thrombectomy as the Treatment of Choice for Ischemic Stroke Large Vessel Acocclusion

Arkus ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. 191-194
Author(s):  
Pinto Desti Ramadhoni
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Stroke Therapy ◽  
Long Term Outcomes ◽  
The Brain ◽  
Improve Blood Flow ◽  
Selection Of

Despite major advances in stroke management in the last 2 decades, stroke is still the leading cause of disability and death worldwide. Current ischemic stroke therapy aims to improve long-term outcomes in stroke patients. For this purpose, early recanalization is the only promising therapy for acute ischemic stroke. The main goal of reperfusion therapy in acute ischemic stroke is to immediately improve blood flow (recanalization) in areas of the brain that are ischemic and have not undergone infarction. The long-term goal is to increase outcomes by reducing disability and death from stroke. The most important factor in the success of reperfusion therapy in acute ischemic stroke is therapy as early as possible. However, selection of suitable candidates for reperfusion therapy requires neurologic evaluation and neuroimaging studies.

Revascularization and functional outcomes after mechanical thrombectomy for acute ischemic stroke in elderly patients

2020 ◽  
Vol 132 (4) ◽  
pp. 1182-1187 ◽  
Author(s):  
Carrie E. Andrews ◽  
Nikolaos Mouchtouris ◽  
Evan M. Fitchett ◽  
Fadi Al Saiegh ◽  
Michael J. Lang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Standard Of Care ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Younger Patients ◽  
Success Of Treatment

OBJECTIVEMechanical thrombectomy (MT) is now the standard of care for acute ischemic stroke (AIS) secondary to large-vessel occlusion, but there remains a question of whether elderly patients benefit from this procedure to the same degree as the younger populations enrolled in the seminal trials on MT. The authors compared outcomes after MT of patients 80–89 and ≥ 90 years old with AIS to those of younger patients.METHODSThe authors retrospectively analyzed records of patients undergoing MT at their institution to examine stroke severity, comorbid conditions, medical management, recanalization results, and clinical outcomes. Univariate and multivariate logistic regression analysis were used to compare patients < 80 years, 80–89 years, and ≥ 90 years old.RESULTSAll groups had similar rates of comorbid disease and tissue plasminogen activator (tPA) administration, and stroke severity did not differ significantly between groups. Elderly patients had equivalent recanalization outcomes, with similar rates of readmission, 30-day mortality, and hospital-associated complications. These patients were more likely to have poor clinical outcome on discharge, as defined by a modified Rankin Scale (mRS) score of 3–6, but this difference was not significant when controlled for stroke severity, tPA administration, and recanalization results.CONCLUSIONSOctogenarians, nonagenarians, and centenarians with AIS have similar rates of mortality, hospital readmission, and hospital-associated complications as younger patients after MT. Elderly patients also have the capacity to achieve good functional outcome after MT, but this potential is moderated by stroke severity and success of treatment.

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