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Advances in endovascular treatment of acute ischaemic stroke
Author(s) -
Asadi H.,
Dowling R.,
Yan B.,
Wong S.,
Mitchell P.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12652
Subject(s) - medicine , solitaire cryptographic algorithm , penumbra , stroke (engine) , thrombolysis , neurovascular bundle , clinical trial , revascularization , randomized controlled trial , stent , embolectomy , surgery , angioplasty , radiology , ischemic stroke , ischemia , myocardial infarction , modified rankin scale , pulmonary embolism , mechanical engineering , engineering
Over the past decade, there have been rapid advancements in ischaemic stroke reperfusion treatments. However, clear clinical benefit is yet to be shown in large clinical trials. In this review, the major studies in different types of endovascular treatments including intra‐arterial thrombolysis, aspiration devices, mechanical clot retrievers and the new stent retrievers are discussed. First‐generation mechanical thrombectomy devices such as the MERCI R etriever (Stryker, Kalamazoo, MI, USA) and P enumbra aspiration device (Penumbra Inc., Alameda, CA, USA) demonstrated safety and higher rates of recanalisation in the MERCI and P enumbra P ivotal S troke T rial; however, there was no significant improvement in clinical outcome. Second‐generation endovascular stent retrieval devices S olitaire (ev3 N eurovascular, I rvine, CA , USA ) and T revo ( S tryker) have shown promising results. In preliminary trials, SOLITAIRE with the I ntention for T hrombectomy (SWIFT) and Thrombectomy Revascularization of Large Vessel Occlusions (TREVO), both showed rates of recanalisation close to 90% and significantly improved clinical outcomes compared with the MERCI study, but the recent landmark studies for endovascular treatment (Interventional Management of Stroke (IMS III), M echanical R etrieval and R ecanalisation of S troke C lots U sing E mbolectomy (MR‐RESCUE) and SYNTHESIS ) did not show any clinical benefit from endovascular treatment compared with standard intravenous therapy. However, moving forward, the recent M ulticenter R andomized C linical T rial of E ndovascular T reatment for Ac ute I schaemic S troke in the N etherlands (MR‐CLEAN) study results have shown marked improvements in recanalisation, reperfusion and functional outcome in patients receiving endovascular treatment (97% using stent retrievers) within 6 h in addition to standard medical care. Overall, although evidence regarding the efficacy of endovascular treatment in acute stroke has been equivocal, recent publications of large multicentre randomised controlled trials indicate benefit of intra‐arterial stent retriever reperfusion in patients selected by appropriate imaging and treated early by experienced operators, and it will likely remain an important adjunct to established medical treatment with intravenous tPA.