What is the Role for Intra-Arterial Therapy in Acute Stroke Intervention?

Cumara B. O'carroll, Mark N. Rubin, Brian W. Chong

Research output: Contribution to journalReview article

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)122-132
Number of pages11
JournalThe Neurohospitalist
Volume5
Issue number3
DOIs
StatePublished - 2015

Keywords

  • carotid artery thrombosis
  • cerebrovascular disease
  • cerebrovascular disorders
  • clinical specialty
  • neurohospitalist
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology

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