A revolution in stroke therapy: reperfusion therapy effective even if late

European Heart Journal Supplements : Journal of the European Society of Cardiology
Danilo ToniLuana Gentile

Abstract

Arterial recanalization procedures after ischaemic stroke, are now well-established treatments, within 5 h for systemic thrombolysis, and 6 h for the endovascular treatment. Ischaemic stroke with uncertain time of symptoms onset, account for 14-27% of the cases, the vast majority of which occur just after waking up, thus it is impossible to derive an exact timeline. Accordingly, these patients are frequently not eligible for acute treatment. The results of three recent trials, DAWN, DEFUSE 3, and WAKE-UP, provided the basis for a revolution in the selection of patients eligible for late revascularization, and revealed an increase in the rate of functional independence for these patients at 90 days (mRS 0-2). Advanced neuroimaging techniques have been shown to be of utmost importance in the definition of the cerebral tissue window. A wider application of these imaging techniques and standardization of the parameters of images acquisition would provide for a significant advancement in the management of ischaemic stroke in the emergency setting.

References

Sep 26, 2008·The New England Journal of Medicine·Werner HackeUNKNOWN ECASS Investigators
Dec 18, 2014·The New England Journal of Medicine·Olvert A BerkhemerUNKNOWN MR CLEAN Investigators
Feb 12, 2015·The New England Journal of Medicine·Bruce C V CampbellUNKNOWN EXTEND-IA Investigators
Feb 12, 2015·The New England Journal of Medicine·Mayank GoyalUNKNOWN ESCAPE Trial Investigators
Apr 18, 2015·The New England Journal of Medicine·Jeffrey L SaverUNKNOWN SWIFT PRIME Investigators
Apr 18, 2015·The New England Journal of Medicine·Tudor G JovinUNKNOWN REVASCAT Trial Investigators
Oct 18, 2015·Annals of Neurology·Gregory W AlbersJeffrey L Saver
Sep 28, 2016·JAMA : the Journal of the American Medical Association·Jeffrey L SaverUNKNOWN HERMES Collaborators
Aug 11, 2017·Stroke; a Journal of Cerebral Circulation·Marcelo Rocha, Tudor G Jovin
Nov 14, 2017·The New England Journal of Medicine·Raul G NogueiraUNKNOWN DAWN Trial Investigators
Jan 25, 2018·The New England Journal of Medicine·Gregory W AlbersUNKNOWN DEFUSE 3 Investigators
May 17, 2018·The New England Journal of Medicine·Götz ThomallaUNKNOWN WAKE-UP Investigators

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Software Mentioned

REVASCAT
MR CLEAN
EXTEND
SWIFT PRIME
WAKE
DEFUSE
ESCAPE
RAPID
- IA

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