Abstract
A new era of stroke treatment may have begun with mechanical thrombectomy (MT) by fully deployed closed-cell self-expanding stents (stent-triever). Multiple case series and the first randomised controlled trials (RCTs) have now been published. More studies are under way involving large numbers of patients, which in turn has resulted in less strict “pragmatic” study protocols. Problems with current trials include a lack of standardisation in the conduct of the recanalisation procedure, the definition of primary endpoints such as the grade of arterial recanalisation and tissue reperfusion, and the post-surgical care provided. In Part 1 of this two part series, we outline the current situation and the major research questions.
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Abbreviations
- ECASS:
-
European Cooperative Acute Stroke Study
- ICSS:
-
International Carotid Stenting Study
- IMS:
-
Interventional Management of Stroke
- MC CLEAN:
-
Multicenter Randomized CLinical trial of endovascular treatment for acute ischemic stroke in The Netherlands.
- NINDS:
-
National Institute of Neurological Disorders and Stroke
- TREVO:
-
Thrombectomy REvascularization of Large Vessel Occlusions in Acute Ischemic Stroke
- THRACE:
-
Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke
- THERAPY:
-
The Randomized, Concurrent Controlled Trial to Assess the Penumbra System’s Safety and Effectiveness in the Treatment of Acute Stroke
- PISTE:
-
Pragmatic ischaemic stroke thrombectomy evaluation
- REVASCAT:
-
RandomizEd trial of reVascularizAtion with Solitaire FR® device vs. best mediCal therapy in the treatment of Acute stroke due to anTerior circulation large vessel occlusion presenting within 8 h of symptom onset
- RIVER:
-
Reperfuse Ischemic Vessels with Endovascular Recanalization
- SPACE:
-
Stent-Protected Angioplasty vs. Carotid Endarterectomy
- SYNTHESIS EXP:
-
SYNTHESIS Expansion
- SWIFT:
-
SOLITAIRE FR With the Intention For Thrombectomy
- ASPECTS:
-
Alberta Stroke Program Early CT
- BCO:
-
balloon guiding catheter occlusion
- BMT:
-
best medical therapy
- CAS:
-
carotid stenting
- CBF:
-
cerebral blood flow
- CBV:
-
cerebral blood volume
- CCA:
-
common carotid artery
- CEA:
-
carotid endarterectomy
- CS:
-
conscious sedation
- CTA:
-
CT-angiography
- CTP:
-
CT-perfusion
- DSA:
-
digital subtraction angiography
- DWI:
-
diffusion weighted imaging
- EIC:
-
early ischemic signs
- ESMINT:
-
European Society of Minimally Invasive Neurological Therapy
- ESNR:
-
European Society of Neuroradiology
- ESO:
-
European Stroke Organisation
- FU:
-
follow up
- GA:
-
general anaesthesia
- ICA:
-
internal carotid artery
- IMS III:
-
Interventional Management of Stroke III Trial
- IVT:
-
intravenous thrombolytical therapy
- MCA:
-
middle cerebral artery
- mRS:
-
modified rankin scale
- MT:
-
mechanical thrombectomy
- NE-CT:
-
non-enhanced CT
- NIH-SS:
-
National Institute of Health Stroke Scale
- PI:
-
perfusion MRI
- RCT:
-
randomised control trial
- sICH:
-
symptomatic intracranial haemorrhage
- stent-triever:
-
self-expanding stents
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Conflict of interest
JF consults for Stryker and Codman, and gives presentations to Covidien, Boehringer Ingelheim, Philips and Siemens MS has a Consultant agreement with Mindframe (now owned by Covidien) and is PI for the Rapid Medical study. FT consults for Stryker and Codman, is on the Codman Board, and has a proctoring agreement and holds workshops for Covidien. RVK receives personal compensation for serving on the Advisory Board of Lundbeck AC, serves as Co-Chair on the Steering Committee of the DIAS-3 and -4 trials, serves on the image adjudication committee for these trials and consults for Synarc; he is Section Editor, Interventional Neuroradiology, of the journal Neuroradiology. MM is a consultant for Synthes, AB Medica/Italy, gives presentations for Johnson & Johnson and has research support from ActiveO. CC consults for Covidien, Stryker, Codman and Microvention. JG is PI of the STAR Study (Covidien).
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Fiehler, J., Söderman, M., Turjman, F. et al. Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients: a position paper endorsed by ESMINT and ESNR. Neuroradiology 54, 1293–1301 (2012). https://doi.org/10.1007/s00234-012-1075-z
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DOI: https://doi.org/10.1007/s00234-012-1075-z