TY - JOUR
T1 - What is the Role for Intra-Arterial Therapy in Acute Stroke Intervention?
AU - O'carroll, Cumara B.
AU - Rubin, Mark N.
AU - Chong, Brian W.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2015/7
Y1 - 2015/7
N2 - Intravenous recombinant tissue plasminogen activator continues to be first-line therapy for patients with acute ischemic stroke presenting within the appropriate time window, but one potential limitation is the low rate of recanalization in the setting of large artery occlusions. Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions, but proof of benefit has been lacking until recently. Our goal is to outline the history of endovascular therapy and review both IA thrombolysis and mechanical interventions. In addition, we will discuss the impact of important trials such as the Third Interventional Management of Stroke (IMS3) trial, and the more recent trials Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits—Intra-Arterial (EXTEND-IA), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) on acute stroke management and the implications for the practicing neurohospitalist.
AB - Intravenous recombinant tissue plasminogen activator continues to be first-line therapy for patients with acute ischemic stroke presenting within the appropriate time window, but one potential limitation is the low rate of recanalization in the setting of large artery occlusions. Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions, but proof of benefit has been lacking until recently. Our goal is to outline the history of endovascular therapy and review both IA thrombolysis and mechanical interventions. In addition, we will discuss the impact of important trials such as the Third Interventional Management of Stroke (IMS3) trial, and the more recent trials Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits—Intra-Arterial (EXTEND-IA), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) on acute stroke management and the implications for the practicing neurohospitalist.
KW - carotid artery thrombosis
KW - cerebrovascular disease
KW - cerebrovascular disorders
KW - clinical specialty
KW - neurohospitalist
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=84993814844&partnerID=8YFLogxK
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U2 - 10.1177/1941874415587681
DO - 10.1177/1941874415587681
M3 - Review article
AN - SCOPUS:84993814844
VL - 5
SP - 122
EP - 132
JO - The Neurohospitalist
JF - The Neurohospitalist
SN - 1941-8744
IS - 3
ER -