Endovascular Treatment For Acute Anterior Circulation Ischemic Stroke - New Evidence And Current Status
Abstract
Endovascular mechanical treatment can remove large proximal clots rapidly and result in higher rates of reperfusion than IV rt-PA alone. Three initial trials of endovascular therapies in 2013 did not show a benefit for thrombectomy over IV rt-PA. But in 2015, 5 trials from around the world, namely MR CLEAN, EXTEND-IA, ESCAPE, SWIFT-PRIME, and REVASCAT, advanced the scope of endovascular therapy for acute ischemic stroke. We review these trials and discuss how they have shaped the current status of endovascular therapy in acute ischaemic stroke.References
1. Broderick JP, Palesch YY, Demchuck AM, Yeatts SD, Khatri P, Hill MD et-al; Interventional Management of Stroke (IMS) III Investigators. Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke. N Engl J Med 2013;368:893-903.
2. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z et-al; MR Rescue Investigators. A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke. N Engl J Med 2013;368:914-923.
3. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R and Boccardi E; SYNTHESIS Expansion Investigators. Endovascular Treatment for Acute Ischemic Stroke. N Engl J Med 2013;368:904-913.
4. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46:3020-35.
5. Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ et al; MR CLEAN Investigators. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med 2015;372:11-20.
6. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N. et al; EXTEND-IA
Investigators. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med 2015;372:1009-18.
7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular
treatment of ischemic stroke. N Engl J Med. 2015;372:1019-30.
8. Barber PA, Demchuk AM, Zhang J et-al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355 (9216): 1670-4.
9. Saver J L, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM et al; SWIFT PRIME Investigators. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N Engl J Med 2015;372:2285-95.
10. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al;
REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296-306.
2. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z et-al; MR Rescue Investigators. A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke. N Engl J Med 2013;368:914-923.
3. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R and Boccardi E; SYNTHESIS Expansion Investigators. Endovascular Treatment for Acute Ischemic Stroke. N Engl J Med 2013;368:904-913.
4. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46:3020-35.
5. Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ et al; MR CLEAN Investigators. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med 2015;372:11-20.
6. Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N. et al; EXTEND-IA
Investigators. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med 2015;372:1009-18.
7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular
treatment of ischemic stroke. N Engl J Med. 2015;372:1019-30.
8. Barber PA, Demchuk AM, Zhang J et-al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355 (9216): 1670-4.
9. Saver J L, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM et al; SWIFT PRIME Investigators. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N Engl J Med 2015;372:2285-95.
10. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al;
REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296-306.
