Open AccessENDOVASCULAR APPROACHES TO ACUTE ISCHEMIC STROKE- INDIAN PERSPECTIVE
Author(s) -
Pramod Dhonde,
N. Kadam
Publication year - 2020
Publication title -
perspectives in medical research
Language(s) - English
Resource type - Journals
eISSN - 2348-229X
pISSN - 2348-1447
DOI - 10.47799/pimr.0703.02
Subject(s) - medicine , thrombolysis , stroke (engine) , acute stroke , occlusion , clinical trial , cardiology , ischemic stroke , ischemia , myocardial infarction , tissue plasminogen activator , mechanical engineering , engineering
Aim: To review literature about endovascular approaches to acute ischemic stroke and provideIndian perspective about managing these cases.Brief Summary: In acute ischemic stroke cases, intravenous thrombolysis (IVT) with altepasewithin 4.5 hours has been the standard of care. Due to certain limitations of IVT, in pooled patientlevel data from 5 trials (HERMES [Highly Effective Reperfusion Evaluated in MultipleEndovascular Stroke Trials], which included the 5 trials MR CLEAN, ESCAPE, REVASCAT,SWIFT PRIME, and EXTEND-IA), mechanical thrombectomy (MT) is indicated for patients withacute ischemic stroke due to a large artery occlusion (LVO) in the anterior circulation who can betreated within 24 hours of the time last known to be well (ie, at neurologic baseline), regardless ofwhether they received intravenous alteplase for the same ischemic stroke event. The maximumbenefit can be achieved within 6 hours of onset of symptoms. There are studies suggesting thebenefit of MT in posterior circulation stroke as well as in distal arteries. We are going to review themethodology of endovascular techniques in brief alongwith Indian perspective on feasibility ofthis treatment approach in AIS.Conclusion: Mechnicalthrombectomy is certainly an effective modality of treatment in largevessel occlusion in anterior circulation within 24 hours. More awareness regarding the approachin India, can reduce the stroke morbidity and mortality in many of the cases in future