This Article Full Text Full Text (PDF) All Versions of this Article: 40/3_suppl_1/S103    most recent STROKEAHA.108.533067v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Broderick, J. P. Search for Related Content PubMed PubMed Citation Articles by Broderick, J. P. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Other Stroke Treatment - Medical

(Stroke. 2009;40:S103.)
© 2009 American Heart Association, Inc.

Reperfusion

Endovascular Therapy for Acute Ischemic Stroke

From the Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio.

Correspondence to Joseph P. Broderick, MD, Department of Neurology, 260 Stetson St, Suite 2300, University of Cincinnati Medical Center, PO Box, Cincinnati, OH. E-mail joseph.broderick{at}uc.edu

Background and Purpose— To review advances in endovascular therapy for acute ischemic stroke.

Methods— Data from primate studies, randomized studies of intravenous recombinant tissue-type plasminogen activator, and nonrandomized and randomized studies of endovascular therapy were reviewed.

Results— Clinical trial data demonstrate the superiority of endovascular treatment with thrombolytic medication or mechanical methods to reopen arteries compared with control patients from the PROACT II Trial treated with heparin alone. However, these same clinical trials, as well as preclinical primate models, indicate that recanalization, whether by endovascular approaches or standard-dose recombinant tissue-type plasminogen activator, is unlikely to improve clinical outcome after a certain time point. Although the threshold beyond which reperfusion has no or little benefit has yet to be conclusively defined, accumulated data to this point indicate an overall threshold of 6 to 7 hours. In addition, although the risk of symptomatic intracerebral hemorrhage is similar in trials of intravenous lytics and endovascular approaches, endovascular approaches have distinctive risk profiles that can impact outcome.

Conclusions— The treatment of acute ischemic stroke is evolving with new tools to reopen arteries and salvage the ischemic brain. Ongoing randomized trials of these new approaches are prerequisite next steps to demonstrate whether reperfusion translates into clinical effectiveness. Physiologic time to reperfusion will remain critical no matter which tools prove most effective and safest.

Key Words: intra-arterial therapy • tissue-type plasminogen activator • Concentric Retriever • EKOS Microinfusion Catheter • acute ischemic stroke • controlled clinical trials

This article has been cited by other articles:

				S. K. Natarajan, K. V. Snyder, A. H. Siddiqui, C. C. Ionita, L. N. Hopkins, and E. I. Levy Safety and Effectiveness of Endovascular Therapy After 8 Hours of Acute Ischemic Stroke Onset and Wake-Up Strokes Stroke, October 1, 2009; 40(10): 3269 - 3274. [Abstract] [Full Text] [PDF]