scholarly journals Endovascular treatment of acute ischemic stroke

2013 ◽  
Vol 04 (03) ◽  
pp. 298-303 ◽  
Author(s):  
Paramdeep Singh ◽  
Rupinderjeet Kaur ◽  
Amarpreet Kaur
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Time Window ◽  
High Rate ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Important Approach ◽  
Stent Retrievers ◽  
Retrievable Stent

ABSTRACTEarly recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS) through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

Abstract TP52: Endovascular Therapy in Patients Over 80 Years of Age With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Janhavi M Modak ◽  
Syed Daniyal Asad ◽  
Jussie Lima ◽  
Amre Nouh ◽  
Ilene Staff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Window ◽  
Extended Time ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Stroke Treatment ◽  
Group A ◽  
Group B

Introduction: Acute ischemic stroke treatment has undergone a paradigm shift, with patients being treated in the extended time window (6-24 hours post symptom onset). The purpose of this study is to assess outcomes in stroke patients above 80 years of age undergoing endovascular treatment (EVT) in the extended time window. Methods: Acute ischemic stroke patients presenting to Hartford Hospital between January 2017 to June 2019 were considered for the study. Stroke outcomes in patients above 80 years of age with anterior circulation ischemic strokes presenting in the extended time window (Group A, n=30) were compared to a younger cohort of patients below 80 years (Group B, n=31). Patients over 80 years treated in the traditional time window (within 6 hours of symptom onset) served as a second set of controls (Group C, n=40). Statistical analysis was performed with a significance level of 0.05 Results: For angiographic results, there were no statistically significant differences in terms of good outcomes (TICI 2b-3) among patients of Group A, when compared to Groups B or C (p>0.05). For the endovascular procedures, no significant differences were noted in the total fluoroscopy time (Median Group A 44.05, Group B 38.1, Group C 35.25 min), total intra-procedure time (Median Group A 144, Group B 143, Group C 126 min) or total radiation exposure (Median Group A 8308, Group B 8960, Group C 8318 uGy-m 2 ). For stroke outcomes, a good clinical outcome was defined as modified Rankin score of 0-2 at discharge. Significantly better outcomes were noted in the younger patients in Group B - 35.4%, when compared to 13.3% in Group A (p=0.03). Comparative outcomes differed in the elderly patients above 80 years, Group A -13.3% vs Group C - 25%, although not statistically significant (p=0.23). There was a significant difference in mortality in patients of Group A - 40% as compared to 12% in the younger cohort, Group B (p= 0.01). Conclusions: In the extended time window, patients above 80 years of age were noted to have a higher mortality, morbidity compared to the younger cohort of patients. No significant differences were noted in the stroke outcomes in patients above 80 years of age when comparing the traditional and the extended time window for stroke treatment.

scholarly journals Lessons from Recent Advances in Ischemic Stroke Management and Targeting Kv2.1 for Neuroprotection

2020 ◽  
Vol 21 (17) ◽  
pp. 6107 ◽  
Author(s):  
Chung-Yang Yeh ◽  
Anthony J. Schulien ◽  
Bradley J. Molyneaux ◽  
Elias Aizenman
Keyword(s):  
Ischemic Stroke ◽  
Time Window ◽  
Stroke Therapy ◽  
Stroke Management ◽  
Preclinical Research ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Cell Death Pathway ◽  
To Receive ◽  
Neuroprotective Therapies

Achieving neuroprotection in ischemic stroke patients has been a multidecade medical challenge. Numerous clinical trials were discontinued in futility and many were terminated in response to deleterious treatment effects. Recently, however, several positive reports have generated the much-needed excitement surrounding stroke therapy. In this review, we describe the clinical studies that significantly expanded the time window of eligibility for patients to receive mechanical endovascular thrombectomy. We further summarize the results available thus far for nerinetide, a promising neuroprotective agent for stroke treatment. Lastly, we reflect upon aspects of these impactful trials in our own studies targeting the Kv2.1-mediated cell death pathway in neurons for neuroprotection. We argue that recent changes in the clinical landscape should be adapted by preclinical research in order to continue progressing toward the development of efficacious neuroprotective therapies for ischemic stroke.

scholarly journals Endovascular thrombectomy for the treatment of acute ischemic stroke

2015 ◽  
Vol 74 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Cleusa P. Ferri ◽  
Anna Buehler ◽  
Uri Adrian Prync Flato ◽  
Paulo Puglia Junior ◽  
Jefferson G. Fernandes
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Treatment ◽  
Current Standard ◽  
Clinical Trial Registry ◽  
Endovascular Thrombectomy ◽  
Randomized Controlled ◽  
Current Standard Treatment ◽  
Unknown Status ◽  
New Treatments

ABSTRACT Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

scholarly journals Update in the Early Management and Reperfusion Strategies of Patients with Acute Ischemic Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Aldo A. Mendez ◽  
Edgar A. Samaniego ◽  
Sunil A. Sheth ◽  
Sudeepta Dandapat ◽  
David M. Hasan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Prehospital Care ◽  
Standard Of Care ◽  
Ongoing Research ◽  
Early Management ◽  
Endovascular Thrombectomy

Acute ischemic stroke (AIS) remains a leading cause of death and long-term disability. The paradigms on prehospital care, reperfusion therapies, and postreperfusion management of patients with AIS continue to evolve. After the publication of pivotal clinical trials, endovascular thrombectomy has become part of the standard of care in selected cases of AIS since 2015. New stroke guidelines have been recently published, and the time window for mechanical thrombectomy has now been extended up to 24 hours. This review aims to provide a focused up-to-date review for the early management of adult patients with AIS and introduce the new upcoming areas of ongoing research.

scholarly journals Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use

2018 ◽  
Vol 7 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Mohamed S. Teleb
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Guide Catheter ◽  
Stent Retrievers ◽  
Number Of Passes ◽  
Single Center Observational Study

Background: Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. Methods: The medical records of a prospectively collected endovascular ischemic stroke database were reviewed. All consecutive strokes when a FlowGate BGC was used with a thrombectomy stent retriever were identified. Use of a FlowGate BGC, number of passes, final Thrombolysis in Cerebral Infarction (TICI) score, trackability, and use of adjunct devices were all collected and analyzed. Results: Use of a FlowGate BGC resulted in 64% (33/52) first-pass effect (FPE) of TICI 2b/3, and specifically 46% (24/52) TICI 3 FPE (true FPE). A total of 52/62 (84%) of thrombectomy cases were treated with BGCs. In the remaining 10, the BGC was not inflated or used due to the clot not being visualized or the lesions being distal and BGC use thus not deemed appropriate. Adjunct use of an aspiration catheter was seen in 12% (6/52) of cases. The overall success with FlowGate BGCs with one or more passes of TICI 2b/3 was 94% (49/52). Trackability was achieved in 92% (57/62) of cases. Conclusions: Use of the FlowGate BGC as an adjunct to mechanical thrombectomy was associated with good FPE and an overall recanalization of TICI 2b/3 of 94%.

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 Lessons from Recent Advances in Ischemic Stroke Management and Targeting Kv2.1 for Neuroprotection

2020 ◽  
Author(s):  
Chung-Yang Yeh ◽  
Anthony Schulien ◽  
Bradley Molyneaux ◽  
Elias Aizenman
Keyword(s):  
Ischemic Stroke ◽  
Time Window ◽  
Stroke Therapy ◽  
Stroke Management ◽  
Preclinical Research ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Cell Death Pathway ◽  
To Receive ◽  
Neuroprotective Therapies

Achieving neuroprotection in ischemic stroke patients has been a multi-decade medical challenge. Numerous clinical trials were discontinued in futility and many were terminated in response to deleterious treatment effects. Recently however, several positive reports have generated the much-needed excitement surrounding stroke therapy. In this review, we describe the clinical studies that significantly expanded the time window of eligibility for patients to receive mechanical endovascular thrombectomy. We summarize the results available thus far for nerinetide, which can be considered the most promising neuroprotective agent yet for stroke treatment. Lastly, we reflect upon aspects of these successful trials in our own studies targeting the Kv2.1-mediated cell death pathway in neurons for neuroprotection. We propose that recent changes in the clinical landscape must be adapted by preclinical research in order to continue progressing toward the development of efficacious neuroprotective therapies for ischemic stroke.

Advances in imaging acute ischemic stroke: evaluation before thrombectomy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Guangchen He ◽  
Liming Wei ◽  
Haitao Lu ◽  
Yuehua Li ◽  
Yuwu Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Imaging Modalities ◽  
Current Evidence ◽  
Endovascular Thrombectomy ◽  
Treatment Paradigm ◽  
Revascularization Therapy ◽  
Magnetic Resonance Imaging Mri

Abstract Recent advances in neuroimaging have demonstrated significant assessment benefits and appropriate triage of patients based on specific clinical and radiological features in the acute stroke setting. Endovascular thrombectomy is arguably the most important aspect of acute stroke management with an extended time window. Imaging-based physiological information may potentially shift the treatment paradigm from a rigid time-based model to a more flexible and individualized, tissue-based approach, increasing the proportion of patients amenable to treatment. Various imaging modalities are routinely used in the diagnosis and management of acute ischemic stroke, including multimodal computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, these imaging methods should provide information beyond the presence or absence of intracranial hemorrhage as well as the presence and extent of the ischemic core, collateral circulation and penumbra in patients with neurological symptoms. Target mismatch may optimize selection of patients with late or unknown symptom onset who would potentially be eligible for revascularization therapy. The purpose of this study was to provide a comprehensive review of the current evidence about efficacy and theoretical basis of present imaging modalities, and explores future directions for imaging in the management of acute ischemic stroke.

Endovascular Treatment of Stroke

2018 ◽  
pp. 153-168
Author(s):  
Mandy J. Binning ◽  
Daniel R. Felbaum
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Heart Association ◽  
Standard Of Care ◽  
Class I ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Intravenous Alteplase

This chapter will review the main endovascular principles of ischemic stroke treatment. Endovascular therapy has been revolutionized by the advent of modern devices for thrombectomy. Class I evidence in multiple trials has proven that intravenous alteplase plus endovascular thrombectomy is superior to intravenous alteplase alone. The combination of these factors has advanced the standard of care for patients who present with acute ischemic stroke who are also found to have a large vessel occlusion and salvageable brain tissue. The chapter will include information based on recently concluded Class I trials and American Heart Association guidelines. The chapter will review available imaging, current guidelines, controversies surrounding endovascular thrombectomy, recent advances in thrombectomy devices, and recent management principles pertinent to the endovascular treatment of acute ischemic stroke. Cases will be presented regarding diagnosis, management, and treatment paradigms currently being practiced.

Sign in / Sign up

Export Citation Format

Share Document