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Expansion of the dimensions in the current management of acute ischemic stroke

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Abstract

Stroke is the fifth leading cause of death in the United States with a huge burden on health care. Acute ischemic stroke (AIS) accounts for 87% of all stroke. The use of thrombolytic agents in AIS treatment is well known since 1950 but no FDA approval until 1996, due to lack of strong evidence showing benefits outweigh the risk of intracranial hemorrhage. The NINDS trial led to the approval of intravenous tissue plasminogen activator treatment (IV recombinant tPA) within 3 h of stroke. Due to this limitation of 3–4.5 h. window, evolution began in the development of effective endovascular therapy (EVT). Multiple trials were unsuccessful in establishing the strong evidence for effectiveness of EVT. In 2015, MR CLEAN trial made progress and showed improved outcomes with EVT in AIS patients with large vessel occlusion (LVO), with 6-h window period. In 2018, two major trials—DAWN and DEFUSE 3—along with few other trials had shown improved outcomes with EVT and stretched window period from 6 to 24 h. AHA Stroke Council is constantly working to provide focused guidelines and recommendations in AIS management since 2013. SVIN had started the initiative “Mission Thrombectomy-2020” to increase global EVT utilization rate 202,000 procedures by 2020. Physicians are using safer and easier approach like brachial and radial approach for EVT. TeleNeurology and artificial intelligence also played a significant role in increasing the availability of IV recombinant tPA in AIS treatment in remote hospitals and also in screening, triaging and identifying LVO patients for EVT. In this review article, we aim to describe the history of stroke management along with the new technological advancements in AIS treatment.

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References

  1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, Ferranti SDd, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P (2017) Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation 135(10):e146–e603. https://doi.org/10.1161/CIR.0000000000000485

    Article  PubMed  PubMed Central  Google Scholar 

  2. Snow SJ (2016) Stroke and t-PA–triggering new paradigms of care. N Engl J Med 374(9):809–811. https://doi.org/10.1056/NEJMp1514696

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fisher M, Schaebitz W (2000) An overview of acute stroke therapy: past, present, and future. Arch Intern Med 160(21):3196–3206. https://doi.org/10.1001/archinte.160.21.3196

    Article  CAS  PubMed  Google Scholar 

  4. Tissue plasminogen activator for acute ischemic stroke (1995) N Engl J Med 333 (24):1581–1587. https://doi.org/10.1056/nejm199512143332401

  5. Chugh C (2019) Acute ischemic stroke: management approach. Indian J Crit Care Med 23(Suppl 2):S140–S146. https://doi.org/10.5005/jp-journals-10071-23192

    Article  PubMed  PubMed Central  Google Scholar 

  6. Goldstein LB (2014) Modern medical management of acute ischemic stroke. Methodist Debakey Cardiovasc J 10(2):99–104. https://doi.org/10.14797/mdcj-10-2-99

    Article  PubMed  PubMed Central  Google Scholar 

  7. Damani R (2018) A brief history of acute stroke care. Aging (Albany NY) 10(8):1797–1798. https://doi.org/10.18632/aging.101542

    Article  Google Scholar 

  8. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282(21):2003–2011. https://doi.org/10.1001/jama.282.21.2003

    Article  CAS  PubMed  Google Scholar 

  9. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731. https://doi.org/10.1016/s0140-6736(16)00163-x

    Article  PubMed  Google Scholar 

  10. Gandhi CD, Al Mufti F, Singh IP, Abruzzo T, Albani B, Ansari SA, Arthur AS, Bain M, Baxter BW, Bulsara KR, Caplan JM, Chen M, Dabus G, Frei D, Hetts SW, Hussain MS, Jayaraman MV, Kayan Y, Klucznik RP, Lee SK, Mack WJ, Leslie-Mazwi T, McTaggart RA, Meyers PM, Mokin M, Patsalides AT, Prestigiacomo CJ, Pride GL Jr, Starke RM, Sunenshine PJ, Fraser JF (2018) Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery. J Neurointerv Surg 10(3):315–320. https://doi.org/10.1136/neurintsurg-2017-013554

    Article  PubMed  Google Scholar 

  11. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG (2018) Thrombectomy 6–24 h after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21. https://doi.org/10.1056/NEJMoa1706442

    Article  PubMed  Google Scholar 

  12. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG (2018) Thrombectomy for stroke at 6–16 h with selection by perfusion imaging. N Engl J Med 378(8):708–718. https://doi.org/10.1056/NEJMoa1713973

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ragoschke-Schumm A, Walter S (2018) DAWN and DEFUSE-3 trials: is time still important? (Die DAWN- und DEFUSE-3-Studie: ist Zeit immer noch wichtig?). Radiologe 58(Suppl 1):20–23. https://doi.org/10.1007/s00117-018-0406-4

    Article  CAS  PubMed  Google Scholar 

  14. Nannoni S, Strambo D, Sirimarco G, Amiguet M, Vanacker P, Eskandari A, Saliou G, Wintermark M, Dunet V, Michel P (2019) Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center. J Neurointerv Surg. https://doi.org/10.1136/neurintsurg-2019-015382

    Article  PubMed  Google Scholar 

  15. Almekhlafi MA, Kunz WG, McTaggart RA, Jayaraman MV, Najm M, Ahn SH, Fainardi E, Rubiera M, Khaw AV, Zini A, Hill MD, Demchuk AM, Goyal M, Menon BK (2020) Imaging triage of patients with late-window (6–24 h) acute ischemic stroke: a comparative study using multiphase CT angiography versus CT perfusion. AJNR Am J Neuroradiol 41(1):129–133. https://doi.org/10.3174/ajnr.A6327

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hill M, Glenn BA, Reese BJ, Morrow B (2018) Recommendations for endovascular care of stroke patients. Interv Neurol 7(1–2):65–90. https://doi.org/10.1159/000481541

    Article  PubMed  Google Scholar 

  17. Chen SH, Snelling BM, Sur S, Shah SS, McCarthy DJ, Luther E, Yavagal DR, Peterson EC, Starke RM (2019) Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes. J Neurointerv Surg 11(9):874–878. https://doi.org/10.1136/neurintsurg-2018-014485

    Article  PubMed  Google Scholar 

  18. Lunagariya A, Patel A, Dalal S, Jani V, Nagaraja N, Huisa B, Hemmen T, Ovbiagele B, Patel U (2018) Abstract TMP84: substantial rise in tPA utilization for acute ischemic stroke in the United States corresponds with significant improvement in outcomes. Stroke 49(Suppl_1):ATMP84. https://doi.org/10.1161/str.49.suppl_1.TMP84

    Article  Google Scholar 

  19. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50(12):e344–e418. https://doi.org/10.1161/STR.0000000000000211

    Article  PubMed  Google Scholar 

  20. Ren Z, Mokin M, Bauer CT, Miao Z, Burgin WS, Wang Y (2019) Indications for mechanical thrombectomy—too wide or too narrow? World Neurosurg 127:492–499. https://doi.org/10.1016/j.wneu.2019.04.116

    Article  PubMed  Google Scholar 

  21. Shams T, Zaidat O, Yavagal D, Xavier A, Jovin T, Janardhan V (2016) Society of Vascular and interventional neurology (SVIN) stroke interventional laboratory consensus (SILC) criteria: A 7M management approach to developing a stroke interventional laboratory in the era of stroke thrombectomy for large vessel occlusions. Interv Neurol 5(1–2):1–28. https://doi.org/10.1159/000443617

    Article  PubMed  PubMed Central  Google Scholar 

  22. Prasad K, Sharma A, Garg A, Mohanty S, Bhatnagar S, Johri S, Singh KK, Nair V, Sarkar RS, Gorthi SP, Hassan KM, Prabhakar S, Marwaha N, Khandelwal N, Misra UK, Kalita J, Nityanand S (2014) Intravenous autologous bone marrow mononuclear stem cell therapy for ischemic stroke: a multicentric, randomized trial. Stroke 45(12):3618–3624. https://doi.org/10.1161/strokeaha.114.007028

    Article  CAS  PubMed  Google Scholar 

  23. Savitz SI, Yavagal D, Rappard G, Likosky W, Rutledge N, Graffagnino C, Alderazi Y, Elder JA, Chen PR, Budzik RF, Tarrel R, Huang DY, Hinson JM (2019) A phase 2 randomized, sham-controlled trial of internal carotid artery infusion of autologous bone marrow–derived ALD-401 cells in patients with recent stable ischemic stroke (RECOVER-Stroke). Circulation 139(2):192–205. https://doi.org/10.1161/circulationaha.117.030659

    Article  PubMed  Google Scholar 

  24. Vu Q, Xie K, Eckert M, Zhao W, Cramer SC (2014) Meta-analysis of preclinical studies of mesenchymal stromal cells for ischemic stroke. Neurology 82(14):1277–1286. https://doi.org/10.1212/WNL.0000000000000278

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kenmuir CL, Wechsler LR (2017) Update on cell therapy for stroke. Stroke Vasc Neurol 2(2):59. https://doi.org/10.1136/svn-2017-000070

    Article  PubMed  PubMed Central  Google Scholar 

  26. Patel UK, Malik P, DeMasi M, Lunagariya A, Jani VB (2019) Multidisciplinary approach and outcomes of tele-neurology: a review. Cureus 11(4):e4410. https://doi.org/10.7759/cureus.4410

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mazighi M, Meseguer E, Labreuche J, Miroux P, Le Gall C, Roy P, Tubach F, Amarenco P (2017) TRUST-tPA trial: telemedicine for remote collaboration with urgentists for stroke-tPA treatment. J Telemed Telecare 23(1):174–180. https://doi.org/10.1177/1357633x15615762

    Article  PubMed  Google Scholar 

  28. Amorim E, Shih MM, Koehler SA, Massaro LL, Zaidi SF, Jumaa MA, Reddy VK, Hammer MD, Jovin TG, Wechsler LR (2013) Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience. J Stroke Cerebrovasc Dis 22(4):527–531. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.02.004

    Article  PubMed  Google Scholar 

  29. Barlinn J, Gerber J, Barlinn K, Pallesen LP, Siepmann T, Zerna C, Wojciechowski C, Puetz V, von Kummer R, Reichmann H, Linn J, Bodechtel U (2017) Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke 12(5):502–509. https://doi.org/10.1177/1747493016681018

    Article  PubMed  Google Scholar 

  30. Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Zieschang K, Fiebach JB, Villringer K, Erdur H, Scheitz JF, Tutuncu S, Bollweg K, Grittner U, Kaczmarek S, Endres M, Nolte CH, Audebert HJ (2016) Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol 15(10):1035–1043. https://doi.org/10.1016/s1474-4422(16)30129-6

    Article  PubMed  Google Scholar 

  31. Patel UK, Anwar A, Saleem S, Malik P, Rasul B, Patel K, Yao R, Seshadri A, Yousufuddin M, Arumaithurai K (2019) Artificial intelligence as an emerging technology in the current care of neurological disorders. J Neurol. https://doi.org/10.1007/s00415-019-09518-3

    Article  PubMed  Google Scholar 

  32. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne M-H, Hennerici M (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: The European Cooperative Acute Stroke Study (ECASS). JAMA 274(13):1017–1025. https://doi.org/10.1001/jama.1995.03530130023023

    Article  CAS  PubMed  Google Scholar 

  33. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). The Lancet 352(9136):1245–1251. https://doi.org/10.1016/S0140-6736(98)08020-9

    Article  CAS  Google Scholar 

  34. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S, Investigators ftAS, (1999) Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3–5 h after symptom onset. The ATLANTIS Study: a randomized controlled trial. JAMA 282(21):2019–2026. https://doi.org/10.1001/jama.282.21.2019

    Article  CAS  PubMed  Google Scholar 

  35. Albers GW, Clark WM, Madden KP, Hamilton SA (2002) ATLANTIS trial: results for patients treated within 3 h of stroke onset alteplase thrombolysis for acute noninterventional therapy in ischemic stroke. Stroke 33(2):493–495. https://doi.org/10.1161/hs0202.102599

    Article  PubMed  Google Scholar 

  36. Ogawa A, Mori E, Minematsu K, Taki W, Takahashi A, Nemoto S, Miyamoto S, Sasaki M, Inoue T (2007) Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 38(10):2633–2639. https://doi.org/10.1161/strokeaha.107.488551

    Article  CAS  PubMed  Google Scholar 

  37. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) Thrombolysis with alteplase 3–4.5 h after acute ischemic stroke. N Engl J Med 359(13):1317–1329. https://doi.org/10.1056/NEJMoa0804656

    Article  CAS  PubMed  Google Scholar 

  38. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Dewey HM, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Ang T, Miteff F, Levi CR, Rodrigues E, Zhao H, Salvaris P, Garcia-Esperon C, Bailey P, Rice H, de Villiers L, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Wong AA, Muller C, Coulthard A, Mitchell K, Clouston J, Mahady K, Field D, Ma H, Phan TG, Chong W, Chandra RV, Slater LA, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM (2018) Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med 378(17):1573–1582. https://doi.org/10.1056/NEJMoa1716405

    Article  CAS  PubMed  Google Scholar 

  39. Ringleb P, Bendszus M, Bluhmki E, Donnan G, Eschenfelder C, Fatar M, Kessler C, Molina C, Leys D, Muddegowda G, Poli S, Schellinger P, Schwab S, Serena J, Toni D, Wahlgren N, Hacke W (2019) Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection. Int J Stroke 14(5):483–490. https://doi.org/10.1177/1747493019840938

    Article  PubMed  Google Scholar 

  40. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Zhao H, Alemseged F, Ng F, Bailey P, Rice H, de Villiers L, Dewey HM, Choi PMC, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Kraemer T, Krause M, Cordato D, Field D, Ma H, O'Brien B, Clissold B, Miteff F, Clissold A, Cloud GC, Bolitho LE, Bonavia L, Bhattacharya A, Wright A, Mamun A, O'Rourke F, Worthington J, Wong AA, Levi CR, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM (2020) Effect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke: the EXTEND-IA TNK part 2 randomized clinical trial. JAMA. https://doi.org/10.1001/jama.2020.1511

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zoppo GJd, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M (1998) PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29(1):4–11. https://doi.org/10.1161/01.STR.29.1.4

    Article  PubMed  Google Scholar 

  42. Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, Starkman S, Grotta J, Spilker J, Khoury J, Brott T (1999) Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke: Emergency Management of Stroke (EMS) Bridging Trial. Stroke 30(12):2598–2605. https://doi.org/10.1161/01.str.30.12.2598

    Article  CAS  PubMed  Google Scholar 

  43. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438. https://doi.org/10.1161/01.STR.0000171066.25248.1d

    Article  PubMed  Google Scholar 

  44. The Interventional Management of Stroke (IMS) II Study (2007) Stroke 38 (7):2127–2135. https://doi.org/10.1161/STROKEAHA.107.483131

  45. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39(4):1205–1212. https://doi.org/10.1161/strokeaha.107.497115

    Article  PubMed  Google Scholar 

  46. The Penumbra Pivotal Stroke Trial (2009) Stroke 40 (8):2761–2768. https://doi.org/10.1161/Strokeaha.108.544957

  47. Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Ossa NPdl, Castellanos M, García MR, Domenech S, Dávalos A, (2010) Mechanical thrombectomy with the solitaire AB device in large artery occlusions of the anterior circulation. Stroke 41(8):1836–1840. https://doi.org/10.1161/Strokeaha.110.584904

    Article  PubMed  Google Scholar 

  48. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923. https://doi.org/10.1056/NEJMoa1212793

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo J-H, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn S-I, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372(11):1019–1030. https://doi.org/10.1056/NEJMoa1414905

    Article  CAS  PubMed  Google Scholar 

  50. Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R, (2015) Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke. N Engl J Med 372(24):2285–2295. https://doi.org/10.1056/NEJMoa1415061

    Article  CAS  PubMed  Google Scholar 

  51. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot J-M, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG (2017) Thrombectomy 6–24 h after stroke with a mismatch between deficit and infarct. N Engl J Med 378(1):11–21. https://doi.org/10.1056/NEJMoa1706442

    Article  PubMed  Google Scholar 

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  1. Department of Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA

    Preeti Malik

  2. Department of Neurology, UH Cleveland Medical Center, Cleveland, OH, USA

    Arsalan Anwar

  3. Department of Internal Medicine, Windsor University School of Medicine, Frankfort, IL, USA

    Ruti Patel

  4. Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Urvish Patel

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Malik, P., Anwar, A., Patel, R. et al. Expansion of the dimensions in the current management of acute ischemic stroke. J Neurol 268, 3185–3202 (2021). https://doi.org/10.1007/s00415-020-09873-6

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