State of acute endovascular therapy: report from the 12th thrombolysis, thrombectomy, and acute stroke therapy conference.
نویسندگان
چکیده
Acute endovascular therapy for ischemic stroke is at a pivotal juncture. Until recently, on the basis of randomized trials comparing devices, we knew that endovascular treatment options were effective in quickly restoring blood flow and that successful early recanalization was associated with better functional outcome when compared with sustained occlusion. We did not have randomized evidence that available acute endovascular therapy improved patient outcomes; the 3 initial randomized controlled trials of endovascular recanalization treatment published in February of 2013—the Phase II Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), Phase III Interventional Management of Stroke (IMS) III, and Local Versus Systemic Thrombolysis for Acute Ischemic Stroke (SYNTHESIS) trials—failed to demonstrate improved clinical outcomes. Many factors may have contributed to the failure of these 3 initial trials to show endovascular benefits. These trials were performed during a period of rapid evolution of imaging and treatment options, and used intra-arterial thrombolysis, or firstgeneration device therapies at best, with little use of newer generation devices, such as stent retrievers, demonstrated to achieve significantly higher rates of recanalization. Patients with mild or moderate stroke severity may have been less likely to benefit from endovascular reperfusion based on IMS III and Prolyse in Acute Cerebral Thromboembolism (PROACT) II post hoc analyses and others. The power of these trials was diluted by State of Acute Endovascular Therapy Report From the 12th Thrombolysis, Thrombectomy, and Acute Stroke Therapy Conference
منابع مشابه
State of Acute Endovascular Therapy Report from the 12th Thrombolysis, Thrombectomy, and Acute Stroke Therapy Conference Special Report
Acute endovascular therapy for ischemic stroke is at a pivotal juncture. Until recently, on the basis of randomized trials comparing devices, we knew that endovascular treatment options were effective in quickly restoring blood flow and that successful early recanalization was associated with better functional outcome when compared with sustained occlusion. We did not have randomized evidence t...
متن کاملFrom the 12 th Thrombolysis , Thrombectomy , and Acute Stroke Therapy Conference
Acute endovascular therapy for ischemic stroke is at a pivotal juncture. Until recently, on the basis of randomized trials comparing devices, we knew that endovascular treatment options were effective in quickly restoring blood flow and that successful early recanalization was associated with better functional outcome when compared with sustained occlusion. We did not have randomized evidence t...
متن کاملState of Acute Endovascular Therapy
Acute endovascular therapy for ischemic stroke is at a pivotal juncture. Until recently, on the basis of randomized trials comparing devices, we knew that endovascular treatment options were effective in quickly restoring blood flow and that successful early recanalization was associated with better functional outcome when compared with sustained occlusion. We did not have randomized evidence t...
متن کاملEndovascular therapy in children with acute ischemic stroke: review and recommendations.
This review provides a summary of the currently available data pertaining to the interventional management of acute ischemic stroke in children. The literature is scarce and is lacking much-needed prospective trials. No study in the literature on the well-established systemic or local thrombolysis trials has included children. Mechanical thrombectomy trials using clot retriever devices have als...
متن کاملCost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke.
OBJECTIVE To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke. METHODS The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-I...
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ورودعنوان ژورنال:
- Stroke
دوره 46 6 شماره
صفحات -
تاریخ انتشار 2015