Endovascular treatment of acute ischemic stroke may be safely performed with no time window limit in appropriately selected patients

Stroke; a Journal of Cerebral Circulation
Alex Abou-Chebl

Abstract

The traditional time window for acute ischemic stroke intra-arterial therapy (IAT) is <6 hours, which is based on pharmacological thrombolysis without penumbral imaging. This study was conducted to determine the safety of patient selection for IAT based on perfusion mismatch rather than time. A cohort of consecutive patients treated with IAT was identified by database review. Patients were selected for IAT based on the presence of perfusion mismatch using CT perfusion or MRI regardless of stroke duration. Thrombolytics were minimized after 6 hours in favor of mechanical embolectomy or angioplasty+/-stenting. Outcomes (National Institutes of Health Stroke Scale, modified Rankin Scale) were assessed by independent examiners. A multivariate analysis was performed to compare those treated <6 hours (early) with those treated >6 hours (late). Fifty-five patients (mean National Institutes of Health Stroke Scale=19.7+/-5.7) were treated, 34 early and 21 late, with mean time-to-intervention of 3.4+/-1.6 hours and 18.6+/-16.0 hours, respectively. Thrombolysis In Myocardial Ischemia 2 or 3 recanalization was achieved in 82.8% early and 85.7% late patients (P=1.0). Intracerebral hemorrhage occurred in 25.5% overall, but symptomatic intrace...Continue Reading

References

Apr 4, 1985·The New England Journal of Medicine·UNKNOWN TIMI Study Group
Dec 14, 1995·The New England Journal of Medicine·UNKNOWN National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group
Mar 11, 2006·Stroke; a Journal of Cerebral Circulation·Rishi GuptaTudor G Jovin
Aug 19, 2007·AJNR. American Journal of Neuroradiology·N A VoraT G Jovin
Feb 2, 2008·Stroke; a Journal of Cerebral Circulation·Jian ZhangJudy Huang
Mar 1, 2008·Stroke; a Journal of Cerebral Circulation·Wade S SmithIsaac E Silverman
Sep 26, 2008·The New England Journal of Medicine·Werner HackeUNKNOWN ECASS Investigators
Oct 2, 2008·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Alex Abou-CheblJay S Yadav

❮ Previous
Next ❯

Citations

Apr 6, 2013·Neuroradiology·C Leiva-SalinasM Wintermark
Jul 3, 2013·Neuroradiology·Oliver C SingerUNKNOWN ENDOSTROKE Study Group
Jul 1, 2011·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Alex Abou-Chebl
Nov 2, 2013·Clinical Neurology and Neurosurgery·Nohra ChalouhiPascal Jabbour
Nov 19, 2013·Journal of Neuroradiology. Journal De Neuroradiologie·Wei-I LeeBernard Yan
Nov 28, 2012·Journal of Neurointerventional Surgery·Aquilla S TurkEdward Jauch
Jun 3, 2011·Neurosurgical Focus·E Jesus DuffisChirag Gandhi
Jun 3, 2011·Neurosurgical Focus·Peter S AmentaPascal Jabbour
Jun 3, 2011·Neurosurgical Focus·George M GhobrialL Fernando Gonzalez
Nov 26, 2013·Journal of Neurosurgery·Abel Po-Hao HuangMax Wintermark
Mar 13, 2014·Journal of Neuroradiology. Journal De Neuroradiologie·Edouard MartinonAdrien Chavent
Jul 22, 2011·Stroke Research and Treatment·Leah J HenningsWilliam C Culp
Jul 12, 2014·Clinical Neurology and Neurosurgery·Jeremiah N JohnsonMohammad A Aziz-Sultan
Oct 18, 2013·Clinical Neuroradiology·M NellesH Urbach
Mar 29, 2014·AJNR. American Journal of Neuroradiology·S PrabhakaranS A Ansari
Jul 11, 2013·Neurocritical Care·Brian P WalcottKevin N Sheth
Feb 2, 2013·Expert Review of Neurotherapeutics·H Steven Block, José Biller
Nov 8, 2013·Expert Review of Cardiovascular Therapy·Thabele M Leslie-MazwiAlbert J Yoo
Feb 8, 2011·Expert Opinion on Pharmacotherapy·Radoslav Raychev, Bruce Ovbiagele
May 11, 2013·British Journal of Neurosurgery·Tomohiro InoueNobuhito Saito
Feb 18, 2014·Current Problems in Cardiology·Stephen R Ramee, Christopher J White
Jul 9, 2013·Journal of Vascular and Interventional Radiology : JVIR·David J BurkartJohn J Borsa
Oct 26, 2013·Neuroimaging Clinics of North America·Sabareesh K NatarajanAdnan H Siddiqui
Apr 3, 2012·Techniques in Vascular and Interventional Radiology·Albert J YooClaus Z Simonsen
Feb 22, 2012·Clinical Neurology and Neurosurgery·Julien JouxDidier Smadja
Jan 4, 2012·World Neurosurgery·Arun Paul Amar
Apr 16, 2011·World Neurosurgery·Peter KanElad I Levy
Mar 5, 2016·Current Treatment Options in Cardiovascular Medicine·Feras AkbikThabele Leslie-Mazwi
Jan 9, 2013·International Journal of Stroke : Official Journal of the International Stroke Society·R SanyalC Roffe
Apr 29, 2015·International Journal of Stroke : Official Journal of the International Stroke Society·Anna H HeBernard Yan
Jan 4, 2012·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Alan FloresMarc Ribo
Jan 9, 2013·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·S JungM Arnold
Dec 5, 2012·Acta Neurologica Scandinavica. Supplementum·C G LundD Russell
Mar 20, 2014·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Alan FloresCarlos A Molina
Oct 9, 2015·Neurology India·Srinivasan Paramasivam
Sep 1, 2015·Journal of Vascular and Interventional Radiology : JVIR·David Sacks
Mar 19, 2015·The New England Journal of Medicine·Olvert A BerkhemerDiederik W J Dippel
May 20, 2015·Current Treatment Options in Neurology·Pedro Telles Cougo-PintoThabele Leslie-Mazwi

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Ischemia

Brain ischemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. Discover the latest research on brain ischemia here.