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Ischemic stroke – novel therapeutic strategies
Author(s) -
Farbu E.,
Kurz K. D.,
Kurz M. W.
Publication year - 2011
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.2011.01540.x
Subject(s) - penumbra , medicine , stroke (engine) , randomized controlled trial , therapeutic window , ischemic stroke , physical medicine and rehabilitation , surgery , cardiology , ischemia , mechanical engineering , engineering , pharmacology
Farbu E, Kurz KD, Kurz MW. Ischemic stroke – novel therapeutic strategies.
Acta Neurol Scand: 2011: 124 (Suppl. 191): 28–37.
© 2011 John Wiley & Sons A/S. Objectives – Treatment of acute, ischemic stroke has changed markedly during the last two decades. We review existing data for optimizing modern stroke care. Results – Implementation of stroke units, giving systematic treatment and observation to stroke patients, has lead to a significant reduction in death and dependency. Introduction of intravenous rt‐PA (IVT) within 3 h for selected stroke patients and recent extension of the time window to 4.5 h improved the outcome even further. Still, one must consider that IVT has several limitations, such as a narrow time window and several contraindications, and the effect is modest, particularly in strokes with a large vessel occlusion. Recanalization of the occluded vessel is a major predictor for good outcome and should be set as a goal. Intra‐arterial rt‐PA (IAT) and the concept of bridging therapy (IVT prior to IAT or thrombectomy with a mechanical device) may improve recanalization rates and outcome. Randomized controlled trials (RCT) are available for IAT, but not for thrombectomy with devices, and we mostly have retrospective non‐controlled data. The Merci‐ and Penumbra system are the most studied devices, for which recent studies report acceptable safety and efficacy. Conclusions – Sufficiently powered RCTs to evaluate the effect of thrombectomy with mechanical devices are warranted, but as the natural course of a large vessel stroke carries a devastating prognosis, a proactive recanalization approach is justified based on today’s knowledge.