1
|
Endovascular treatment achieves better outcomes than best medical management in patients with M2 occlusion and high stroke severity: a meta-analysis. J Neurol 2023; 270:2924-2937. [PMID: 36862149 DOI: 10.1007/s00415-023-11653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for patients with M2 occlusion. This study aims to compare the efficacy and safety of endovascular treatment (EVT) with best medical management (BMM) in patients with M2 occlusion, and to investigate whether the optimal treatment varies according to stroke severity. METHODS Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT and BMM. According to stroke severity, the study population were classified into those with moderate-severe stroke and those with mild stroke. National Institute of Health Stroke Scale (NIHSS) scores ≥ 6 was defined as moderate-severe stroke, and NIHSS scores 0-5 as mild stroke. Random-effects meta-analyses were performed to measure the symptomatic intracranial hemorrhage (sICH) within 72 h, and the modified Rankin Scale (mRS) scores 0-2 and the mortality at 90 days. RESULTS Totally, 20 studies were identified, including 4358 patients. In the moderate-severe stroke population, the EVT had 82% higher odds for mRS scores 0-2 (OR 1.82, 95% CI 1.34-2.49) and a 43% lower odds for mortality (OR 0.57, 95% CI 0.39-0.82) compared with the BMM. However, no difference was found in the sICH rate (OR 0.88, 95% CI 0.44-1.77). In the mild stroke population, no differences were observed in the mRS scores 0-2 (OR 0.81, 95% CI 0.59-1.10) or mortality (OR 1.23, 95% CI 0.72-2.10) between EVT and BMM, whereas EVT was associated with higher sICH rate (OR 4.21, 95% CI 1.86-9.49). CONCLUSION EVT may be only beneficial for patients with M2 occlusion and high stroke severity, but not for those with NIHSS scores 0-5.
Collapse
|
2
|
Muhl H, Roth C, Schröter A, Politi M, Alexandrou M, Dahl J, Gindorf S, Papanagiotou P, Kastrup A. Pneumonia in Acute Ischemic Stroke Patients with Proximal Occlusions within the Anterior Circulation after Endovascular Therapy or Systemic Thrombolysis. J Clin Med 2022; 11:jcm11030482. [PMID: 35159933 PMCID: PMC8836980 DOI: 10.3390/jcm11030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
While endovascular treatment (ET) improves clinical outcomes in patients with proximal vessel occlusions compared to thrombolysis (IVT), the impact of ET on the frequency of stroke-associated pneumonia (SAP) is uncertain. We compared the rates of SAP in patients with large vessel occlusions in the anterior circulation after IVT or ET. We also determined risk factors for SAP, as well as the impact of SAP on early clinical outcomes. A total of 544 patients were treated with IVT, and 1061 patients received ET (with or without IVT). The rates of SAP did not differ significantly between ET (217/1061; 20%) and IVT (100/544; 18%) (p = 0.3). Overall, the occurrence of SAP was significantly associated with mortality and a poor clinical outcome. In the multivariable regression analysis, age, sex, the presence of dysphagia, early signs of ischemia on imaging and a history of stroke and mechanical ventilation were all significantly associated with the occurrence of SAP. In patients with large vessel occlusions, the introduction of ET did not result in lower rates of SAP compared with IVT. There is an ongoing need to reduce the rates of SAP in this patient population, for which the risk factors found here could become useful.
Collapse
Affiliation(s)
- Henning Muhl
- Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (H.M.); (A.S.); (J.D.); (S.G.)
| | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (C.R.); (M.P.); (M.A.); (P.P.)
| | - Andreas Schröter
- Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (H.M.); (A.S.); (J.D.); (S.G.)
| | - Maria Politi
- Department of Neuroradiology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (C.R.); (M.P.); (M.A.); (P.P.)
| | - Maria Alexandrou
- Department of Neuroradiology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (C.R.); (M.P.); (M.A.); (P.P.)
| | - Janina Dahl
- Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (H.M.); (A.S.); (J.D.); (S.G.)
| | - Susanne Gindorf
- Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (H.M.); (A.S.); (J.D.); (S.G.)
| | - Panagiotis Papanagiotou
- Department of Neuroradiology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (C.R.); (M.P.); (M.A.); (P.P.)
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, St.-Jürgen-Street 1, 28177 Bremen, Germany; (H.M.); (A.S.); (J.D.); (S.G.)
- Department of Neurology, University of Göttingen, Robert-Koch-Street 40, 37075 Göttingen, Germany
- Correspondence:
| |
Collapse
|
3
|
Zhao Z, Zhang J, Jiang X, Wang L, Yin Z, Hall M, Wang Y, Lai L. Is Endovascular Treatment Still Good for Ischemic Stroke in Real World?: A Meta-Analysis of Randomized Control Trial and Observational Study in the Last Decade. Stroke 2020; 51:3250-3263. [PMID: 32921259 DOI: 10.1161/strokeaha.120.029742] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Although endovascular treatment (EVT) for acute ischemic stroke is classified as I evidence, outcomes after EVT in real-world practice appear to be less superior than those in randomized clinical trials (RCTs). Additionally, the effect of EVT is unclear compared with medical treatment (MT) for patients with mild symptoms defined by National Institutes of Health Stroke Scale score <6 or with severe symptoms defined by Alberta Stroke Program Early CT Score <6. METHODS Literatures were searched in big databases and major meetings from December 6, 2009, to December 6, 2019, including RCTs and observational studies comparing EVT against MT for patients with acute ischemic stroke. Observational studies were precategorized into 3 groups based on imaging data on admission: mild stroke group with National Institutes of Health Stroke Scale score <6, severe stroke group with Alberta Stroke Program Early CT Score <6 or ischemic core ≥50 mL, and normal stroke group for all others. Outcome was measured as modified Rankin Scale score of 0 to 2, mortality at 90 days, and symptomatic intracranial hemorrhage (sICH) at 24 hours. RESULTS Fifteen RCTs (n=3694) and 37 observational studies (n=9090) were included. EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality in RCTs and normal stroke group, whereas EVT was associated with higher sICH rate in normal stroke group, and no difference of sICH rate appeared between EVT and MT in RCTs. In severe stroke group, EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality, whereas no difference of sICH rate was found. In mild stroke group, there was no difference in modified Rankin Scale 0 to 2 rate between EVT and MT, whereas EVT was associated with higher mortality and sICH rate. CONCLUSIONS Evidence from RCTs and observational studies supports the use of EVT as the first-line choice for eligible patients corresponding to the latest guideline. For patients with Alberta Stroke Program Early CT Score <6, EVT showed superiority over MT, also in line with the guidelines. On the contrary to the guideline, our data do not support EVT for patients with National Institutes of Health Stroke Scale score <6.
Collapse
Affiliation(s)
- Zixu Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,Queen Mary School, Jiangxi Medical College (Z.Z., J.Z.), Nanchang University, Jiangxi, PR China
| | - Jiarui Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,Queen Mary School, Jiangxi Medical College (Z.Z., J.Z.), Nanchang University, Jiangxi, PR China
| | - Xin Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,The First Clinical Medical School, Jiangxi Medical College (X.J.), Nanchang University, Jiangxi, PR China
| | - Li Wang
- Centre for Evidence-Based Medicine, School of Public Health (L.W.), Nanchang University, Jiangxi, PR China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, PR China (Z.Y.)
| | - Michael Hall
- Institute of Ophthalmology, University College London, United Kingdom (M.H.)
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.)
| | - Lingfeng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.)
| |
Collapse
|
4
|
Abstract
Despite several effective strategies of stroke prevention, the stroke epidemic still constitutes the leading cause of permanent disability. The recent series of well-designed, convincingly-positive randomized controlled trials of endovascular thrombectomy in stroke patients with large vessel occlusion launched a paradigm shift and a new era in acute stroke management. The present review provides an overview of the technical aspects of the procedure, discusses patient selection criteria, summarizes the current evidence from randomized trials about its efficacy and safety, and explores its implications in the organization of acute stroke care.
Collapse
Affiliation(s)
- Panagiotis Papanagiotou
- From the Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.); Saarland University, Germany (P.P.); and Department of Medicine, University of Thessaly, Larissa, Greece (G.N.).
| | - George Ntaios
- From the Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.); Saarland University, Germany (P.P.); and Department of Medicine, University of Thessaly, Larissa, Greece (G.N.)
| |
Collapse
|
5
|
Meyer L, Alexandrou M, Leischner H, Flottmann F, Deb-Chatterji M, Abdullayev N, Maus V, Politi M, Roth C, Kastrup A, Thomalla G, Mpotsaris A, Fiehler J, Papanagiotou P. Mechanical thrombectomy in nonagenarians with acute ischemic stroke. J Neurointerv Surg 2019; 11:1091-1094. [DOI: 10.1136/neurintsurg-2019-014785] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/04/2022]
Abstract
BackgroundMechanical thrombectomy (MT) is a safe and effective therapy for ischemic stroke. Nevertheless, very elderly patients aged ≥90 years were either excluded or under-represented in previous trials. It remains uncertain whether MT is warranted for this population or whether there should be an upper age limit.MethodsWe retrospectively reviewed 79 patients with stroke aged ≥90 years from three neurointerventional centers who underwent MT between 2013 and 2017. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 90-day follow-up. Successful recanalization was graded by Thrombolysis in Cerebral Infarction Scale (TICI) ≥2 b. Feasibility and safety assessments included unsuccessful recanalization attempts (TICI 0), time from groin puncture to recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events.ResultsOnly occlusions within the anterior circulation were included. Median time from groin puncture to recanalization was 39 min (IQR 25–57 min). The rate of successful recanalization (TICI ≥2 b) was 69.6% (55/79). Good functional outcome (mRS ≤2) at 90 days was observed in 16% (12/75) of patients. In-hospital mortality was 29.1% (23/79) and increased significantly at 90 days (46.7%, 35/75; p<0.001). sICH occurred in 5.1% (4/79) of patients. No independent predictor for good functional outcome (mRS ≤2) at 90 days was identified through logistic regression analysis.ConclusionMT in nonagenarians leads to high mortality rates and less frequently good functional outcome compared with younger patient cohorts in previous large randomized trials. However, MT appears to be safe and beneficial for a certain number of very elderly patients and therefore should generally not be withheld from nonagenarians.
Collapse
|
6
|
Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Giessing C, Papanagiotou P. Endovascular Therapy versus Thrombolysis in Patients with Mild Strokes and Large Vessel Occlusions within the Anterior Circulation. INTERVENTIONAL NEUROLOGY 2018; 7:431-438. [PMID: 30410521 DOI: 10.1159/000489708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
Background In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, it is currently unclear if patients with mild strokes also benefit from ET. Methods We compared the discharge rates of good outcome (modified Rankin scale [mRS] ≤2), very good outcome (mRS 0-1), symptomatic intracranial hemorrhages (SICH), and infarct sizes in patients with mild strokes (admission National Institutes of Health Stroke Scale ≤10) and distal intracranial carotid artery, M1, and M2 occlusions during two time periods. Results From 1/2008 to 10/2012 160 patients (mean age: 72 ± 12 years) were treated with IVT, and from 11/2012 to 11/2016 145 patients (mean age: 71 ± 13 years,) received ET with or without IVT. The clinical results were comparable between both treatment groups (59% after ET vs. 56% after IVT, p = 0.5 for an mRS 0-2) and (38% after ET vs. 32% after IVT, p = 0.3 for an mRS 0-1). In the subgroup of patients with an mRS ≤6, the early outcome did not differ significantly between ET and IVT either. The rates of SICH as well as the infarct sizes were not significantly different after ET compared with IVT. Conclusion Compared with IVT, the routine use of ET did not significantly improve the early clinical or radiological outcome in patients with mild strokes and anterior circulation large vessel occlusions. Further randomized trials are urgently needed to determine the role of ET in this cohort.
Collapse
Affiliation(s)
- Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany.,Department of Neurology, University of Göttingen, Göttingen, Germany
| | | | | | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | | | - Carsten Giessing
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | |
Collapse
|
7
|
Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Papanagiotou P. Endovascular therapy versus thrombolysis in patients with large vessel occlusions within the anterior circulation aged ≥80 years. J Neurointerv Surg 2018; 10:1053-1056. [PMID: 29549121 DOI: 10.1136/neurintsurg-2017-013732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain. METHODS Using our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0-1), poor outcome (mRS 5-6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods. RESULTS From January 2008 to October 2012, 217 patients were treated with IVT and, from November 2012 to October 2017, 209 patients received ET with stent retrievers (with or without IVT). Significantly more patients in the ET group than in the IVT group had a good outcome (25% vs 16%, P<0.05), as well as an excellent outcome (12% vs 4%, P<0.01). Significantly fewer patients in the ET group than in the IVT group died (14% vs 22%, P<0.05) or had a poor outcome (35% vs 52%, P<001). The SICH rates were lower after ET than after IVT (1% vs 6%, P<0.01), and the infarct sizes were smaller after ET than after IVT. CONCLUSIONS Compared with IVT, the routine use of ET significantly improved the early clinical and radiological outcome in patients with anterior circulation large vessel occlusions aged ≥80 years. Nevertheless, poor outcome rates were high so the role of ET needs to be defined further in this population.
Collapse
Affiliation(s)
- Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | - Freimuth Brunner
- Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | | | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | | | | |
Collapse
|
8
|
Salahuddin H, Espinosa A, Buehler M, Khuder SA, Khan AR, Tietjen G, Zaidi S, Jumaa MA. Mechanical Thrombectomy for Middle Cerebral Artery Division Occlusions: A Systematic Review and Meta-Analysis. INTERVENTIONAL NEUROLOGY 2017; 6:242-253. [PMID: 29118802 DOI: 10.1159/000477589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Middle cerebral artery division (M2) occlusion was significantly underrepresented in recent mechanical thrombectomy (MT) randomized controlled trials, and the approach to this disease remains heterogeneous. Objective To conduct a systematic review and meta-analysis of outcomes at 90 days among patients undergoing MT for M2 middle cerebral artery (MCA) occlusions. Methods Five clinical databases were searched from inception through September 2016. Observational studies reporting 90-day modified Rankin Scale scores for patients undergoing MT for M2 MCA occlusions with an M1 MCA control group were selected. The primary outcome of interest was good clinical outcome 90 days after MT of an M1 or M2 MCA occlusion. Secondary outcomes of interest included mortality and excellent clinical outcome, recanalization rates, significant intracerebral hemorrhage, and procedural complications. Results A total of 323 publications were identified, and 237 potentially relevant articles were screened. Six studies were included in the analysis (M1 = 1,203, M2 = 258; total n = 1,461). We found no significant differences in good clinical outcomes (1.10 [95% CI, 0.83-1.44]), excellent clinical outcomes (1.07 [0.65-1.79]), mortality at 3 months (0.85 [0.58-1.24]), recanalization rates (1.06 [0.32-3.48]), and significant intracranial hemorrhage (1.19 [0.61-2.30]). Conclusions MT of M2 MCA occlusions is as safe as that of main trunk MCA occlusions, and comparable in terms of clinical outcomes and hemorrhagic complications. Randomized clinical trials are needed to assess the impact of MT in patients with M2 occlusions, given that M1 MCA occlusions have different natural histories than M2 occlusions.
Collapse
Affiliation(s)
- Hisham Salahuddin
- Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Aixa Espinosa
- Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mark Buehler
- Department of Radiology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Abdur R Khan
- Department of Cardiology Division, University of Louisville, Louisville, Kentucky, USA
| | - Gretchen Tietjen
- Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Syed Zaidi
- Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Mouhammad A Jumaa
- Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
| |
Collapse
|
9
|
Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Gießing C, Papanagiotou P. THRIVE score predicts clinical and radiological outcome after endovascular therapy or thrombolysis in patients with anterior circulation stroke in everyday clinical practice. Eur J Neurol 2017; 24:1032-1039. [PMID: 28556351 DOI: 10.1111/ene.13328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Based on the data of several trials the Totaled Health Risks in Vascular Events (THRIVE) score has been shown to predict outcome after either intravenous thrombolysis (IVT) or endovascular therapy (ET) in acute stroke patients. It is unknown whether the THRIVE score can also predict outcome in everyday clinical practice. Using our prospectively obtained stroke database the utility of the THRIVE score to predict clinical and radiological outcome in everyday clinical practice was analysed. METHODS The relationships between THRIVE and good outcome (modified Rankin Scale ≤ 2 at discharge), poor outcome (modified Rankin Scale 5-6), in-hospital death, symptomatic intracranial haemorrhage (SICH) as well as infarct size were examined in patients with distal intracranial carotid artery, M1 and M2 occlusions after either IVT or ET. RESULTS From January 2008 to October 2016 a total of 546 patients were treated with IVT and 492 patients received ET with stent retrievers (with or without IVT). In both treatment groups the THRIVE score predicted clinical outcome (Mantel-Haenszel chi-squared tests for trend P < 0.001 for good outcome, P < 0.001 for poor outcome and P < 0.001 for in-hospital death). In the ET group the THRIVE score remained an independent predictor of outcome after controlling for recanalization. The THRIVE score was associated with the infarct size after IVT or ET, whereas it did not predict SICH rates in either treatment group. CONCLUSIONS In everyday clinical practice the THRIVE score strongly predicts clinical outcome and the extent of ischaemia after ET or IVT in patients with anterior circulation large vessel occlusions.
Collapse
Affiliation(s)
- A Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - F Brunner
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - C Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - M Winterhalter
- Department of Anesthesiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - C Gießing
- Department of Psychology, European Medical School, University of Oldenburg, Oldenburg, Germany
| | - P Papanagiotou
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| |
Collapse
|
10
|
Politi M, Kastrup A, Marmagkiolis K, Grunwald IQ, Papanagiotou P. Endovascular Therapy for Acute Stroke. Prog Cardiovasc Dis 2017; 59:534-541. [PMID: 28365297 DOI: 10.1016/j.pcad.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 11/25/2022]
Abstract
Stroke is the most common cause of permanent disability, the second most common cause of dementia, and the fourth most common cause of death in the Western world. Recently, based on positive multicenter randomized clinical trials, endovascular therapy for acute stroke has undergone a revolution. Routine mechanical thrombectomy in addition to intravenous thrombolysis has been shown to provide excellent outcomes for patients with proximal anterior circulation occlusions. This procedure reduces disability and benefits are seen across a wide range of age and initial stroke severity. Important features that affect treatment decisions include time of presentation, the patient's clinical status, imaging characteristics, and lab tests. Under optimal conditions, it should be available to patients 24/7, similar to systems offering prompt percutaneous coronary interventions to patients with acute ST-segment elevation myocardial infarctions.
Collapse
Affiliation(s)
- Maria Politi
- Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte
| | | | | | - Iris Q Grunwald
- Neuroscience and Vascular Simulation Unit, Anglia Ruskin University, Essex, UK
| | - Panagiotis Papanagiotou
- Clinic for Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte; Neuroscience and Vascular Simulation Unit, Anglia Ruskin University, Essex, UK.
| |
Collapse
|