Intra-Arterial Therapy for Acute Ischemic Stroke: a Golden Age

Author:

Cougo-Pinto Pedro Telles,Chandra Ronil V.,Simonsen Claus Z.,Hirsch Joshua A.,Leslie-Mazwi Thabele

Publisher

Springer Science and Business Media LLC

Subject

Neurology (clinical)

Reference78 articles.

1. Lima FO, Furie KL, Silva GS, Lev MH, Camargo ECS, Singhal AB, et al. Prognosis of untreated strokes due to anterior circulation proximal intracranial arterial occlusions detected by use of computed tomography angiography. JAMA Neurol. 2014;71(2):151–7.

2. Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2014;372(1):11–20. These five contemporary trials (references 2-6) comparing intra-arterial therapy to best medical care represent a landmark in acute stroke care. They converge in some critical aspects: the high recanalization rates, the careful selection of eligible patients, the emphasis on early intervention, and the remarkably high effect size of benefit.

3. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. The EXTEND-IA was the smallest of the recent trials and showed benefit of IAT using a perfusion based selection paradigm.

4. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. The ESCAPE trial was characterized by using collateral assessment to aid the selection of eligible patients and by the emphasis on shortening times from admission to reperfusion in enrolling sites.

5. Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015. doi: 10.1056/NEJMoa1415061 . SWIFT-PRIME used penumbral mismatch for the first 71 patients enrolled, and then a “small core” criterion for eligibility. Only patients who had received IV TPA were eligible. SWIFT PRIME presented the highest reperfusion rate of these positive trials.

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