Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach.

Therapeutic Advances in Neurological Disorders
Georgios MagoufisGeorgios Tsivgoulis

Abstract

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for compl...Continue Reading

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Citations

Aug 24, 2021·Clinical Hemorheology and Microcirculation·Carolina Rio BartulosPhilipp Wiggermann
Sep 25, 2021·Expert Opinion on Investigational Drugs·Apostolos SafourisGeorgios Tsivgoulis

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Software Mentioned

SPIRAL
DEFUSE
ASPECTS
Rapid Processing of Perfusion and Diffusion ( RAPID )
DAWN
CT Perfusion 4D
EVT
MR CLEAN
iSchemaView
REVASCAT

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