Skip to main content

Advertisement

SpringerLink
Log in

Interventional Management of Acute Ischemic Stroke: A Systematic Review

  • Vascular Disease (R Schainfeld, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Historically, acute ischemic stroke (AIS) trials defined syndromes according to acute clinical presentation and post-ictus parenchymal imaging. With improvements in real-time arterial imaging, modern AIS treatment demands a structural approach based upon the level of cerebrovascular occlusion. The poor concordance of presenting National Institute of Health Stroke Scale (NIHSS) with vessel occlusion in recent trials bespeaks the need for an anatomic perspective. Specifically, patients with large-vessel occlusion (LVO) represent a distinct entity with a poorer prognosis than general AIS patients. Ongoing clinical trials and therapeutic strategies must recognize the varied natural history of AIS patients. Endovascular therapy offers promise in patients with the most severe strokes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: Final Data for 2009. Nat Vital Stat Rep. 2011;60(3).

  2. Khalessi AA, Fargen KM, Lavine S, Mocco J. Commentary: societal statement on recent acute stroke intervention trials: results and implications. Neurosurgery. 2013;73(2):E375–9. This publication represents the first complete consensus statement on catheter-based therapy for that was endorsed by the five major societies involved in catheter-based AIS treatment, including the Joint Cerebrovascular Section of the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), the Society of Vascular and Interventional Neurology (SVIN), the Society of NeuroInterventional Surgery (SNIS), and the American Society of NeuroRadiology (ASNR).

    Article  PubMed  Google Scholar 

  3. Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999;282(21):2003–11.

    Article  CAS  PubMed  Google Scholar 

  4. Janardhan V, Gianatasio RM, Chen SH, et al. Abstract 194: preliminary results from the FIRST trial: a natural history of acute stroke from large vessel occlusion. Stroke. 2013;44:A194. This publication reinforced the distinctively poor natural history of AIS due to LVO.

    Google Scholar 

  5. Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368(10):893–903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wolpert SM, Bruckmann H, Greenlee R, Wechsler L, Pessin MS, del Zoppo GJ. Neuroradiologic evaluation of patients with acute stroke treated with recombinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. AJNR Am J Neuroradiol. 1993;14(1):3–13.

    CAS  PubMed  Google Scholar 

  7. Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368(10):904–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Pexmana JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol. 2001;22:1534–42.

    Google Scholar 

  9. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274:1017–25.

    Article  CAS  PubMed  Google Scholar 

  10. Boxerman JL, Jayaraman MV, Mehan WA, Rogg JM, Haas RA. Clinical stroke penumbra: use of National Institutes of Health Stroke Scale as a surrogate for CT perfusion in patient triage for intra-arterial middle cerebral artery stroke therapy. AJNR Am J Neuroradiol. 2012;33:1893–900.

    Article  CAS  PubMed  Google Scholar 

  11. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967–73.

    Article  PubMed  Google Scholar 

  12. Fargen KM, Meyers PM, Khatri P, Mocco J. Improvements in recanalization with modern stroke therapy: a review of prospective ischemic stroke trials during the last two decades. 2013;5(6):506–11. doi: 10.1136/neurintsurg-2012-010541

  13. Saver JL, Jahan R, Levy EI, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380(9849):1241–9. This was the first study to objectively demonstrate the superiority of retrievable stents over the Merci device in the treatment of AIS.

    Article  PubMed  Google Scholar 

  14. Nogueira RG, Lutsep HL, Gupta R, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40.

    Article  PubMed  Google Scholar 

  15. Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ciccone A. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7.

    Article  Google Scholar 

  17. Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. doi:10.1161/STR.0b013e318284056a.

    Article  PubMed  Google Scholar 

  18. Adeoye O, Hornung R, Khatri P, Kleindorfer D. Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke. 2011;42(7):1952–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Morgenstern LB, Staub L, Chan W, et al. Improving delivery of acute stroke therapy: the TLL Temple Foundation Stroke Project. Stroke. 2002;33(1):160–6.

    Article  PubMed  Google Scholar 

  20. de Los Ríos la Rosa F, Khoury J, Kissela BM, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European Cooperative Acute Stroke Study (ECASS) III Trial. Stroke. 2012;43(6):1591–5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. J. Scott Pannell and Dr. David R. Santiago-Dieppa each declare no potential conflicts of interest relevant to this article.

Dr. Alexander Khalessi is a consultant for Stryker and Covidien. Dr. Khalessi received payment for development of educational presentations including service on speakers’ bureaus from Covidien, Stryker, Penumbra, and Codman and research support from Penumbra.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, University of California, San Diego, 200 West Arbor Drive, San Diego, CA, 92103, USA

    J. Scott Pannell MD, David R. Santiago-Dieppa MD & Alexander A. Khalessi MD, MS, FAHA

Authors
  1. J. Scott Pannell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David R. Santiago-Dieppa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander A. Khalessi MD, MS, FAHA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander A. Khalessi MD, MS, FAHA.

Additional information

This article is part of the Topical Collection on Vascular Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scott Pannell, J., Santiago-Dieppa, D.R. & Khalessi, A.A. Interventional Management of Acute Ischemic Stroke: A Systematic Review. Curr Treat Options Cardio Med 16, 318 (2014). https://doi.org/10.1007/s11936-014-0318-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-014-0318-1

Keywords

Search

Navigation