Impact of Mechanical Thrombectomy on the Organization of the Management of Acute Ischemic Stroke

European Neurology
Benoît DaubailMaurice Giroud

Abstract

Several trials and meta-analyses have recently demonstrated the superiority of endovascular therapy over standard medical treatment in patients presenting with acute ischemic stroke. In order to offer the best possible treatment to a maximum number of patients, many stroke care networks probably have to be reorganized. After analyzing the reliability of data in the literature, an algorithm is suggested for a pre-hospital and in-hospital alert system to improve the timeliness of subsequent treatment: a drip-and-ship approach. Five recent well-designed randomized studies have demonstrated the benefit of endovascular therapy associated with intravenous fibrinolysis by recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with confirmation by recent meta-analyses. The keys for success are a very short time to reperfusion, within 6 h, a moderate to severe pre-treatment deficit (National Institute of Health around 17), cerebral imaging able to identify proximal large vessel occlusion in the anterior circulation, a limited infarct core and a reversible penumbra, the use of the most recent devices (stent retriever) and a procedure that avoids general anesthesia, which reduces blood pressure. To meet these goals, ev...Continue Reading

Citations

Mar 19, 2016·Expert Review of Neurotherapeutics·Georgios TsivgoulisAndrei V Alexandrov
Oct 6, 2017·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·T V KharitonovaA Yu Polushin
Jun 22, 2018·Frontiers in Neurology·Rosa M Vivanco-HidalgoMiquel Gallofré
Jul 20, 2019·Therapeutic Advances in Neurological Disorders·Andrei V AlexandrovUNKNOWN CLOTBUST-ER Trial Investigators

❮ Previous
Next ❯

Related Concepts

Related Feeds

Acute Stroke

A stroke occurs when blood supply to the brain is interrupted depriving the brain of oxygen and nutrients. This feed focuses cerebrovascular accidents including ischemic and paralytic stroke.

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.

Related Papers

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
Shinichi YoshimuraSeigo Shindo
Stroke; a Journal of Cerebral Circulation
James C Grotta, W Hacke
© 2022 Meta ULC. All rights reserved