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Critical Early Thrombolytic and Endovascular Reperfusion Therapy for Acute Ischemic Stroke Victims: a Call for Adjunct Neuroprotection

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Abstract

Today, there is an enormous amount of excitement in the field of stroke victim care due to the recent success of MR. CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, and REVASCAT endovascular trials. Successful intravenous (IV) recombinant tissue plasminogen activator (rt-PA) clinical trials [i.e., National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trial, Third European Cooperative Acute Stroke Study (ECASSIII), and Third International Stroke study (IST-3)] also need to be emphasized. In the recent endovascular and thrombolytic trials, there is statistically significant improvement using both the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Score (mRS) scale, but neither approach promotes complete recovery in patients enrolled within any particular NIHSS or mRS score tier. Absolute improvement (mRS 0–2 at 90 days) with endovascular therapy is 13.5–31 %, whereas thrombolytics alone also significantly improve patient functional independence, but to a lesser degree (NINDS rt-PA trial 13 %). This article has 3 main goals: (1) first to emphasize the utility and cost-effectiveness of rt-PA to treat stroke; (2) second to review the recent endovascular trials with respect to efficacy, safety, and cost-effectiveness as a stroke treatment; and (3) to further consider and evaluate strategies to develop novel neuroprotective drugs. A thesis will be put forth so that future stroke trials and therapy development can optimally promote recovery so that stroke victims can return to “normal” life.

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Conflict of Interest

PAL serves as Editor-in-Chief of the Journal of Neurology and Neurophysiology and Associate Editor of Translational Stroke Research. The scientific content of this work was not directly supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS), or any other funding source external to Cedars-Sinai Medical Center. PAL was supported in part by a U01 Translational research grant NS060685 for initial concepts of this article.

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Lapchak, P.A. Critical Early Thrombolytic and Endovascular Reperfusion Therapy for Acute Ischemic Stroke Victims: a Call for Adjunct Neuroprotection. Transl. Stroke Res. 6, 345–354 (2015). https://doi.org/10.1007/s12975-015-0419-5

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