Past, Present, and Future Perspectives on the Endovascular Treatment of Acute Ischemic Stroke
Section snippets
Prolyse in Acute Cerebral Thromboembolism I (1998, N = 46)
The prolyse in acute cerebral thromboembolism (PROACT) trial was a multicenter, prospective, randomized controlled trial that compared the efficacy of direct IA infusion of pro-urokinase (pro-UK) versus placebo for the treatment of symptomatic middle cerebral artery (MCA) occlusion within 6 hours of stroke onset.14 Pro-UK is a proenzyme that is locally converted to urokinase by fibrin-associated plasmin at the thrombus surface, and whose effects are augmented by the presence of heparin. It is
Ongoing Trials
To avoid the need for antiplatelet agents following stent deployment, hybrid devices are now being introduced that combine removable intracranial stenting and thrombectomy: the “Solitaire FR With the Intention for Thrombectomy”24 (Fig. 3) and the “Thrombectomy Revascularization of Large Vessel Occlusion in Acute Ischemic Stroke” (TREVO),25 and the trials are underway on similar devices.
Logistics of Care
Improved stroke care begins at the pre-hospital stage; The California Acute Stroke Prototype Registry investigators estimate >10-fold increase in the number of patients receiving appropriate treatment if the hospital arrival time is within 1 hour of symptom onset,26 highlighting the importance of public education and emergency medical services response time. Future first responders to the scene of a suspected stroke may be able to perform real-time neuroimaging rapidly with subsequent
Conclusions
Neurointerventional surgery for the treatment of ischemic stroke is a rapidly expanding field with constantly improving tools and ever evolving indications. Recanalization rates appear to be on the rise in more recent studies compared to early studies. As data continues to accumulate regarding new treatment modalities and technologies, neurosurgeons, radiologists and neurologists should come together to design new treatment paradigms. Much work remains to streamline the care of stroke patients
References (40)
- et al.
Acute vertebral-basilar thrombosisAngiologic-clinical comparison and therapeutic implications
Acta Radio Suppl
(1986) - et al.
Thrombolytic therapy of acute basilar artery occlusionVariables affecting recanalization and outcome
Stroke
(1996) - et al.
‘Malignant’ middle cerebral artery territory infarction: Clinical course and prognostic signs
Arch Neurol
(1996) - et al.
Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation
Am J Neuroradiol
(1995) - et al.
Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials
Lancet
(2004) - et al.
Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease
Stroke
(1988) - et al.
Predictors of clinical improvement, angiographic recanalization, and intracranial hemorrhage after intra-arterial thrombolysis for acute ischemic stroke
Stroke
(1999) - et al.
New magnetic resonance techniques for acute ischemic stroke
JAMA
(1995) - et al.
Correlations between MR diffusion perfusion studies and MRA in acute stroke
Neurology
(1999) Tissue plasminogen activator for acute ischemic strokeThe National Institute of Neurological Disorders and Stroke rt-pa stroke study group
N Engl J Med
(1995)
Intravenous tissue plasminogen activator ameliorates the outcome of hyperacute embolic stroke
Cerebrovasc Dis
Combined intravenous and intra-arterial recanalization for acute ischemic stroke: The interventional management of stroke study
Stroke
The interventional management of stroke (IMS) II study
Stroke
PROACT: A phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery strokePROACT investigators. Prolyse in acute cerebral thromboembolism
Stroke
Intra-arterial prourokinase for acute ischemic strokeThe PROACT II study: A randomized controlled trial. Prolyse in acute cerebral thromboembolism
JAMA
Quality improvement and tissue-type plasminogen activator for acute ischemic stroke: A cleveland update
Stroke
Adult stroke: part 9
Circulation
Intra-arterial stroke therapy: An assessment of demand and available work force
Am J Neuroradiol
Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke emergency management of stroke (EMS) bridging trial
Stroke
Safety and efficacy of mechanical embolectomy in acute ischemic stroke results of the MERCI trial
Stroke
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New mechanical thrombectomy model in the rabbit: A feasibility study
2016, Journal of Neuroscience MethodsCitation Excerpt :Its reported complications include cerebral hemorrhage, thrombus dislocation and vessel rupture (Campbell et al., 2015; Goyal et al., 2015). To minimize complications and to further improve clinical outcome many research groups focus on the development of new and improved devices (Arnaout et al., 2012). The most important precondition for reliable results of experimental studies is the use of an adequate animal model mimicking human conditions.
L-NAME combats excitotoxicity and recuperates neurological deficits in MCAO/R rats
2015, Pharmacology Biochemistry and BehaviorCitation Excerpt :Treatment of cerebral ischaemia still remains a daunting due to its complex pathophysiological cascade and lack of time dependent therapeutic intervention (Trent et al., 2012). Though treatments such as thrombolytic agents (tissue plasminogen activator and pro-urokinase) and other endovascular procedures are currently available, pitfall like long and poor recanalisation rates, vascular rupture (haemorrhagic) and vasospasm restricts their use (Paramdeep et al., 2013; Kurre et al., 2013; Arnaout et al., 2012; Davalos et al., 2005). Extensive investigations over the past few decades revealed generation of nitric oxide, as one of the primary ground for the devastating effects of cerebral ischaemia.
Advantages and limitations of anesthesia and sedation practices used during endovascular revascularization therapy among acute ischemic stroke patients
2013, Journal of Radiology NursingCitation Excerpt :Endovascular revascularization procedures for AIS, especially off-label use of endovascular thrombolysis with tPA, continues to be rare and controversial because of the potential risk of intracranial hemorrhage and other procedure-related complications. At the same time, the logistics of the procedure delivery have not been established yet (Arnaout et al., 2012). The choice of conscious sedation versus general anesthesia must be considered carefully based on the knowledge of the procedure, patient history, and limitations of each of the anesthesia techniques.
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