Skip to main content

Acute Management Strategies: tPA and Mechanical Thrombectomy Trials

  • Chapter
  • First Online:
The Acute Neurology Survival Guide

Abstract

This chapter provides a comprehensive but concise overview of important trials in tPA trials, mechanical thrombectomy trials, bridging trials, high-risk but non-disabling strokes, extracranial disease, severe intracranial stenosis, and PFO closure trials.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

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

    Article  Google Scholar 

  2. Bluhmki E, et al. Stroke treatment with alteplase given 3· 0–4· 5 h after onset of acute ischaemic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial. Lancet Neurol. 2009;8(12):1095–102.

    Article  CAS  Google Scholar 

  3. Thomalla G, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611–22.

    Article  Google Scholar 

  4. Furlan A, et al. Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study: a randomized controlled trial. JAMA. 1999;282(21):2003–11.

    Article  CAS  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;368:893–903.

    Article  CAS  Google Scholar 

  6. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.

    Article  Google Scholar 

  7. Goyal M, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

    Article  CAS  Google Scholar 

  8. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.

    Article  CAS  Google Scholar 

  9. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.

    Article  Google Scholar 

  10. Albers GW, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18.

    Article  Google Scholar 

  11. Snelling B, et al. Extended window for stroke thrombectomy. J Neurosci Rural Pract. 2019;10(2):294–300. https://doi.org/10.4103/jnrp.jnrp_365_18.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, Peng Y, Han H, Wang J, Wang S, DIRECT-MT Investigators, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med. 2020;382:1981–93.

    Article  CAS  Google Scholar 

  13. Suzuki K, et al. The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study). Int J Stroke. 2019;14(7):752–5.

    Article  Google Scholar 

  14. Zi W, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA. 2021;325(3):234–43.

    Article  CAS  Google Scholar 

  15. Wang Y, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11–9.

    Article  CAS  Google Scholar 

  16. Johnston SC, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379(3):215–25.

    Article  CAS  Google Scholar 

  17. Johnston SC, et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med. 2020;383(3):207–17.

    Article  CAS  Google Scholar 

  18. Bhatia K, et al. Dual antiplatelet therapy versus aspirin in patients with stroke or transient ischemic attack: meta-analysis of randomized controlled trials. Stroke. 2021;52(6):e217–23.

    Article  CAS  Google Scholar 

  19. North American Symptomatic Carotid Endarterectomy Trial Collaborators*. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53.

    Article  Google Scholar 

  20. Brott TG, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.

    Article  CAS  Google Scholar 

  21. Amarenco P, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020;382(1):9–19.

    Article  CAS  Google Scholar 

  22. Chimowitz MI, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352(13):1305–16.

    Article  CAS  Google Scholar 

  23. Derdeyn CP, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet. 2014;383(9914):333–41.

    Article  Google Scholar 

  24. Søndergaard L, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377(11):1033–42.

    Article  Google Scholar 

  25. Mas J-L, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377(11):1011–21.

    Article  CAS  Google Scholar 

  26. Saver JL, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377(11):1022–32.

    Article  Google Scholar 

  27. Turc G, et al. Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke with patent foramen ovale: systematic review of randomized trials, sequential meta-analysis, and new insights from the CLOSE study. J Am Heart Assoc. 2018;7(12):e008356. https://doi.org/10.1161/JAHA.117.008356.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Catherine S. W. Albin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Albin, C.S.W., Zafar, S.F. (2022). Acute Management Strategies: tPA and Mechanical Thrombectomy Trials. In: Albin, C.S., Zafar, S.F. (eds) The Acute Neurology Survival Guide. Springer, Cham. https://doi.org/10.1007/978-3-030-75732-8_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-75732-8_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-75731-1

  • Online ISBN: 978-3-030-75732-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics