Changing management of acute ischaemic stroke: the new treatments and emerging role of endovascular therapy

Asadi, Hamed, Williams, David and Thornton, John 2016, Changing management of acute ischaemic stroke: the new treatments and emerging role of endovascular therapy, Current treatment options in neurology, vol. 18, pp. 1-19, doi: 10.1007/s11940-016-0403-8.

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Title Changing management of acute ischaemic stroke: the new treatments and emerging role of endovascular therapy
Author(s) Asadi, HamedORCID iD for Asadi, Hamed
Williams, David
Thornton, John
Journal name Current treatment options in neurology
Volume number 18
Article ID 20
Start page 1
End page 19
Total pages 19
Publisher Springer
Place of publication New York, N.Y.
Publication date 2016-05
ISSN 1092-8480
Keyword(s) haemorrhage
stent retriever
Summary OPINION STATEMENT: Urgent reperfusion of the ischaemic brain is the aim of stroke treatment, and the last two decades have seen a rapid advancement in the medical and endovascular treatment of acute ischaemic stroke. Intravenous tissue plasminogen activator (tPA) was first introduced as a safe and effective thrombolytic agent followed by the introduction of newer thrombolytic agents as well as anticoagulant and antiplatelet agents, proposed as potentially safer drugs with more favourable interaction profiles. In addition to chemo-thrombolysis, other techniques including transcranial sonothrombolysis and microbubble cavitation have been introduced which are showing promising results, but await large-scale clinical trials. These developments in medical therapies which are undoubtedly of great importance due to their potential widespread and immediate availability are paralleled with gradual but steady improvements in endovascular recanalisation techniques which were initiated by the introduction of the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) and Penumbra systems. The introduction of the Solitaire device was a significant achievement in reliable and safe endovascular recanalisation and was followed by further innovative stent retrievers. Initial trials failed to show a solid benefit in endovascular intervention compared with IV-tPA alone. These counterintuitive results did not last long, however, when a series of very well-designed randomised controlled trials, pioneered by MR-CLEAN, EXTEND-IA and ESCAPE, emerged, confirming the well-believed daily anecdotal evidence. There have now been seven positive trials of endovascular treatment for acute ischaemic stroke. Now that level I evidence regarding the superiority of endovascular recanalisation is abundantly available, the clinical challenge is how to select patients suitable for intervention and to familiarise and educate stroke care providers with this recent development in stroke care. It is important for the interventional services to be provided only in comprehensive stroke centres and endovascular interventions attempted by experienced well-trained operators, at this stage as an adjunct to the established medical treatment of IV-tPA, if there are no contraindications.
Language eng
DOI 10.1007/s11940-016-0403-8
Field of Research 110299 Cardiorespiratory Medicine and Haematology not elsewhere classified
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, Springer Science + Business Media New York
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Document type: Journal Article
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