Advertisement

Intravenous Thrombolytic and Endovascular Treatment of Acute Ischemic Stroke

  • Ameer Al-Wafai
  • William Humphries
  • Lucas ElijovichEmail author
Reference work entry

Abstract

Acute ischemic stroke is a disease with an immense global impact. The past 30 years has seen an explosion in diagnostic and therapeutic options that has changed the way stroke is treated. We will review the scientific evidence for acute ischemic stroke therapy, discuss new treatment algorithms and systems of care, and also review the available imaging modalities utilized for patient selection as well as endovascular devices/techniques that are employed to treat acute large vessel intracranial occlusions, one of the most difficult subtypes of acute ischemic stroke.

Keywords

Acute Ischemic Stroke Tissue Plasminogen Activator Acute Ischemic Stroke Patient Stent Retriever Large Vessel Occlusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Glossary of Terms

Tissue Plasminogen Activator (TPA)

A fibrinolyic medication that can be administered both intravenously and intraarterially.

Large Vessel Occlusion

Intracranial occlusion of one of the major arteries of the circle of willis including the internal carotid artery, anterior cerebral artery, middle cerebral artery, vertebral artery, basilar artery, and posterior cerebral arteries

Mechanical Embolectomy

A catheter based technique used to perform acute ischemic stroke surgery that utilizes fluoroscopically visualized devices that remove emboli with suction/aspiration or retrievable stents.

Multi-Modal Stroke Imaging

CT or MRI based techniques employing a combination of image sequences that evaluate brain tissue integrity, the cervico-cerebral vasculature, and brain perfusion in order to best select patients for thrombolysis with IV TPA and/or mechanical embolectomy

References

  1. Abul-Kasim K, Brizzi M, Petersson J (2010) Hyperdense middle cerebral artery sign is an ominous prognostic marker despite optimal workflow. Acta Neurol Scand 122:132–139PubMedGoogle Scholar
  2. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41CrossRefPubMedGoogle Scholar
  3. Adeoye O, Hornung R, Khatri P, Kleindorfer D (2011) 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 42:1952–1955CrossRefPubMedPubMedCentralGoogle Scholar
  4. Albers GW, Thijs VN, Wechsler L, Kemp S, Schlaug G, Skalabrin E, Bammer R, Kakuda W, Lansberg MG, Shuaib A, Coplin W, Hamilton S, Moseley M, Marks MP, Investigators DEFUSE (2006) Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann Neurol 60:508–517CrossRefPubMedGoogle Scholar
  5. Alexandrov AV, Burgin WS, Demchuk AM et al (2001) Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy: sonographic classification and short-term improvement. Circulation 103:2897–2902CrossRefPubMedGoogle Scholar
  6. Barazangi N, Wintermark M, Lease K, Rao R, Smith W, Josephson SA (2011) Comparison of computed tomography angiography and transesophageal echocardiography for evaluating aortic arch disease. J Stroke Cerebrovasc Dis 20(5):436–442CrossRefPubMedGoogle Scholar
  7. Barber PA, Demchuk AM, Hudon ME, Pexman JH, Hill MD, Buchan AM (2001) Hyperdense sylvian fissure MCA “dot” sign: a CT marker of acute ischemia. Stroke 32:84–88CrossRefPubMedGoogle Scholar
  8. Barber PA, Hill MD, Eliasziw M, Demchuk AM, Pexman JH, Hudon ME, Tomanek A, Frayne R, Buchan AM, ASPECTS Study Group (2005) Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 76(11):1528–1533CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, Saver J, Sayre J (2005) Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR 26:1012–1021PubMedGoogle Scholar
  10. Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P et al (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41(10):2254–2258CrossRefPubMedGoogle Scholar
  11. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, Silver FL, von Kummer R, Molina CA, Demaerschalk BM, Budzik R, Clark WM, Zaidat OO, Malisch TW, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Martin RH, Foster LD, Tomsick TA, Interventional Management of Stroke (IMS) III Investigators (2013) Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368(10):893–903CrossRefPubMedPubMedCentralGoogle Scholar
  12. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, Boccardi E (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368(10):904–913CrossRefPubMedPubMedCentralGoogle Scholar
  13. Cleveland Clinic. Neurosciences Institute. Outcomes 2011. pp 36–37Google Scholar
  14. Dani KA, Thomas RG, Chappell FM et al (2011) Computed tomography and magnetic resonance perfusion imaging in ischemic stroke: definitions and thresholds. Ann Neurol 70:384–401CrossRefPubMedGoogle Scholar
  15. Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, Barber PA, Bladin C, De Silva DA, Byrnes G, Chalk JB, Fink JN, Kimber TE, Schultz D, Hand PJ, Frayne J, Hankey G, Muir K, Gerraty R, Tress BM, Desmond PM, EPITHET Investigators (2008) Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 7:299–309CrossRefPubMedGoogle Scholar
  16. Ezzeddine MA, Lev MH, McDonald CT, Rordorf G, Oliveira-Filho J, Aksoy FG, Farkas J, Segal AZ, Schwamm LH, Gonzalez RG, Koroshetz WJ (2002) CT angiography with whole brain perfused blood volume imaging: added clinical value in the assessment of acute stroke. Stroke 33:959–966CrossRefPubMedGoogle Scholar
  17. Flacke S, Urbach H, Keller E, Träber F, Hartmann A, Textor J, Gieseke J, Block W, Folkers PJ, Schild HH (2000) Middle cerebral artery (MCA) susceptibility sign at susceptibility-based perfusion MR imaging: clinical importance and comparison with hyperdense MCA sign at CT. Radiology 215:476–482CrossRefPubMedGoogle Scholar
  18. Frei D, Yoo A, Heck D et al (2012) Pretreatment CTA ASPECTS as a predictor of clinical outcome in endovascular stroke therapy (EVT): results from the penumbra START trial. Society of NeuroInterventional Surgery 2012 annual meeting, 24 July 2012, San Diego, abstract: O-001Google Scholar
  19. Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial pro-urokinase for acute ischemic stroke – the PROACT II study: a randomized controlled trial. JAMA 282:2003–2011CrossRefPubMedGoogle Scholar
  20. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2013) Heart disease and stroke statistics: 2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245Google Scholar
  21. Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, Chou MJ, Biagini T, Smith WS, Harris GJ, Dillon WP, Gonzalez RG, Koroshetz WJ, Lev MH (2009) Hyperdense basilar artery sign on unenhanced CT predicts thrombus and outcome in acute posterior circulation stroke. Stroke 40:134–139CrossRefPubMedGoogle Scholar
  22. González RG (2012) Low signal, high noise and large uncertainty make CT perfusion unsuitable for acute ischemic stroke patient selection for endovascular therapy. J Neurointerv Surg 4(4):242–245CrossRefPubMedGoogle Scholar
  23. Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D (1984) Racial differences in the distribution of anterior circulation occlusive disease. Neurology 34(1):54–59CrossRefPubMedGoogle Scholar
  24. Graham GD (2003) Tissue plasminogen activator for acute ischemic stroke in clinical practice: a meta-analysis of safety data. Stroke 34(12):2847–2850CrossRefPubMedGoogle Scholar
  25. Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, Glahn J, Brandt T, Hacke W, Diener HC (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32(11):2559–2566CrossRefPubMedGoogle Scholar
  26. Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S, ATLANTIS Trials Investigators, ECASS Trials Investigators, NINDS rt-PA Study Group Investigators (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774CrossRefPubMedGoogle Scholar
  27. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) ECASS investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329CrossRefPubMedGoogle Scholar
  28. Hopyan J, Ciarallo A, Dowlatshahi D, Howard P, John V, Yeung R, Zhang L, Kim J, MacFarlane G, Lee TY, Aviv RI (2010) Certainty of stroke diagnosis: incremental benefit with CT perfusion over noncontrast CT and CT angiography. Radiology 255(1):142–153CrossRefPubMedGoogle Scholar
  29. Ingall TJ, O'Fallon WM, Asplund K, Goldfrank LR, Hertzberg VS, Louis TA, Christianson TJ (2004) Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 35(10):2418–2424CrossRefPubMedGoogle Scholar
  30. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology (2013) 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 44(3):870–947CrossRefPubMedGoogle Scholar
  31. Jovin TG, Liebeskind DS, Gupta R, Rymer M, Rai A, Zaidat OO, Abou-Chebl A, Baxter B, Levy EI, Barreto A, Nogueira RG (2011) Imaging-based endovascular therapy for acute ischemic stroke due to proximal intracranial anterior circulation occlusion treated beyond 8 hours from time last seen well: retrospective multicenter analysis of 237 consecutive patients. Stroke 42(8):2206–2211CrossRefPubMedGoogle Scholar
  32. Kharitonova T, Ahmed N, Thoren M, Wardlaw JM, von Kummer R, Glahn J et al (2009) Hyperdense middle cerebral artery sign on admission CT scan – prognostic significance for ischaemic stroke patients treated with intravenous thrombolysis in the safe implementation of thrombolysis in stroke international stroke thrombolysis register. Cerebrovasc Dis 27:51–59CrossRefPubMedGoogle Scholar
  33. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL, MR RESCUE Investigators (2013a) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368(10):914–923CrossRefPubMedPubMedCentralGoogle Scholar
  34. Kidwell CS, Wintermark M, De Silva DA, Schaewe TJ, Jahan R, Starkman S, Jovin T, Hom J, Jumaa M, Schreier J, Gornbein J, Liebeskind DS, Alger JR, Saver JL (2013b) Multiparametric MRI and CT models of infarct core and favorable penumbral imaging patterns in acute ischemic stroke. Stroke 44(1):73–79CrossRefPubMedGoogle Scholar
  35. Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW (2012) DEFUSE 2 study investigators. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 11(10):860–867CrossRefPubMedPubMedCentralGoogle Scholar
  36. Larrue V, von Kummer R, del Zoppo G, Bluhmki E (1997) Hemorrhagic transformation in acute ischemic stroke: potential contributing factors in the European Cooperative Acute Stroke Study. Stroke 28:957–960CrossRefPubMedGoogle Scholar
  37. Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ, Hopkins LN, Mocco J (2009) First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke 40(11):3552–3556CrossRefPubMedGoogle Scholar
  38. Lima FO, Furie KL, Silva GS et al (2010) The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 41:2316–2322CrossRefPubMedPubMedCentralGoogle Scholar
  39. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y; American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2009) Heart disease and stroke statistics: 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):e21–e181Google Scholar
  40. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD, American Heart Association Strategic Planning Task Force and Statistics Committee (2010) Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation 121(4):586–613Google Scholar
  41. Manno EM, Nichols DA, Fulgham JR, Wijdicks EF (2003) Computed tomographic determinants of neurologic deterioration in patients with large middle cerebral artery infarctions. Mayo Clin Proc 78:156–160CrossRefPubMedGoogle Scholar
  42. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley EC Jr, Lewandowski CA, Kwiatkowski TP (2000) Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 55:1649–1655CrossRefPubMedGoogle Scholar
  43. Maroo A, Topol EJ (2004) The early history and development of thrombolysis in acute myocardial infarction. J Thromb Haemost 2:1867–1870CrossRefPubMedGoogle Scholar
  44. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M (2012) Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79(4):306–313CrossRefPubMedGoogle Scholar
  45. Moulin T, Cattin F, Crépin-Leblond T, Tatu L, Chavot D, Piotin M, Viel JF, Rumbach L, Bonneville JF (1996) Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and outcome. Neurology 47:366–375CrossRefPubMedGoogle Scholar
  46. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS, TREVO 2 Trialists (2012) Trevo versus merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380(9849):1231–1240CrossRefPubMedPubMedCentralGoogle Scholar
  47. Ogawa A, Mori E, Minematsu K et al (2007) Randomized trial of intra-arterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 38:2633–2639CrossRefPubMedGoogle Scholar
  48. Penumbra Pivotal Stroke Trial Investigators (2009) The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40(8):2761–2768CrossRefGoogle Scholar
  49. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, Hu WY, Buchan AM (2001) Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR 22(8):1534–1542PubMedGoogle Scholar
  50. Redon J (2011) Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and central Asia: implications for control of high blood pressure. Eur Heart J 32(11):1424–1431CrossRefPubMedGoogle Scholar
  51. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO, SWIFT Trialists (2012) Solitaire flow restoration device versus the merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380(9849):1241–1249CrossRefPubMedGoogle Scholar
  52. Schaefer PW, Roccatagliata L, Ledezma C, Hoh B, Schwamm LH, Koroshetz W, Gonzalez RG, Lev MH (2006) First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy. AJNR Am J Neuroradiol 27:20–25PubMedGoogle Scholar
  53. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP, MERCI Trial Investigators (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438CrossRefPubMedGoogle Scholar
  54. Smith WS, Tsao JW, Billings ME, Johnston SC, Hemphill JC 3rd, Bonovich DC, Dillon WP (2006) Prognostic significance of angiographically confirmed large vessel intracranial occlusion in patients presenting with acute brain ischemia. Neurocrit Care 4:14–17CrossRefPubMedGoogle Scholar
  55. Soares BP, Tong E, Hom J, Cheng SC, Bredno J, Boussel L, Smith WS, Wintermark M (2010) Reperfusion is a more accurate predictor of follow-up infarct volume than recanalization: a proof of concept using CT in acute ischemic stroke patients. Stroke 41(1):e34–e40CrossRefPubMedGoogle Scholar
  56. Souza LC, Yoo AJ, Chaudhry ZA, Payabvash S, Kemmling A, Schaefer PW, Hirsch JA, Furie KL, González RG, Nogueira RG, Lev MH (2012) Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. AJNR Am J Neuroradiol 33(7):1331–1336CrossRefPubMedPubMedCentralGoogle Scholar
  57. Tan JC, Dillon WP, Liu S et al (2007) Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol 61:533–543CrossRefPubMedGoogle Scholar
  58. Tan IY, Demchuk AM, Hopyan J et al (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30:525–531CrossRefPubMedGoogle Scholar
  59. Tekle WG, Chaudhry SA, Hassan AE, Rodriguez GJ, Suri MF, Qureshi AI (2012) Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the united states. Stroke 43(7):1971–1974CrossRefPubMedGoogle Scholar
  60. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587CrossRefGoogle Scholar
  61. Turk AS, Magarick JA, Frei D, Fargen KM, Chaudry I, Holmstedt CA, Nicholas J, Mocco J, Turner RD, Huddle D, Loy D, Bellon R, Dooley G, Adams R, Whaley M, Fanale C, Jauch (2013a) CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study. Neurointerv Surg 5(6):523–527CrossRefGoogle Scholar
  62. Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, Siddiqui A, Mokin M, Dewan M, Woo H, Turner R, Hawk H, Miranpuri A, Chaudry I (2013b) Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 6:231–237CrossRefPubMedGoogle Scholar
  63. von Kummer R, Bourquain H, Bastianello S, Bozzao L, Manelfe C, Meier D, Hacke W (2001) Early prediction of irreversible brain damage after ischemic stroke at CT. Radiology 219:95–100CrossRefGoogle Scholar
  64. Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A, Erilä T, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Köhrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G, Safe Implementation of Thrombolysis in Stroke- MOnitoring STudy Investigators (2008) Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST). Stroke 39:3316–3322CrossRefPubMedGoogle Scholar
  65. White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, Sacco RL (2005) Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 111(10):1327–1331CrossRefPubMedGoogle Scholar
  66. Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, Anderson J, Nesbit G, Gabriely I, Medina V, Quiles A, Pohlman S, Quist M, Schnyder P, Bogousslavsky J, Dillon WP, Pedraza S (2006) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 37:979–985CrossRefPubMedGoogle Scholar
  67. Yoo AJ, Verduzco LA, Schaefer PW et al (2009) MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 40:2046–2054CrossRefPubMedPubMedCentralGoogle Scholar

Further Reading

  1. Moll R, Dinkel HP (2001) Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler. Eur J Radiol 39:155–162CrossRefPubMedGoogle Scholar
  2. Solitaire™ FR as primary treatment for acute ischemic stroke (SWIFT PRIME). NCT01657461Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ameer Al-Wafai
    • 1
  • William Humphries
    • 2
  • Lucas Elijovich
    • 2
    • 1
    Email author
  1. 1.Department of NeurologyUniversity of Tennessee Health Sciences CenterMemphisUSA
  2. 2.Department of Neurosurgery, Semmes-Murphey Neurologic InstituteUniversity of Tennessee Health Sciences CenterMemphisUSA

Personalised recommendations