Interventional Management of Acute Ischemic Stroke: A Systematic Review

  • J. Scott Pannell
  • David R. Santiago-Dieppa
  • Alexander A. Khalessi
Vascular Disease (R Schainfeld, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Vascular Disease

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.

Keywords

Acute ischemic stroke Large-vessel occlusion CT angiography Intra-arterial stroke therapy Endovascular therapy Retrievable stent 

References and Recommended Reading

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

  1. 1.
    Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: Final Data for 2009. Nat Vital Stat Rep. 2011;60(3).Google Scholar
  2. 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).PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 7.
    Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368(10):904–13.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 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. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967–73.PubMedCrossRefGoogle Scholar
  12. 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. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • J. Scott Pannell
    • 1
  • David R. Santiago-Dieppa
    • 1
  • Alexander A. Khalessi
    • 1
  1. 1.Division of NeurosurgeryUniversity of California, San DiegoSan DiegoUSA

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