Georgios Tsivgoulis1,2,3,4, Apostolos Safouris1,2,5, Christos Krogias6,7, Adam S Arthur8, Andrei V Alexandrov3. 1. a Second Department of Neurology , Attikon University Hospital , Athens , Greece. 2. b School of Medicine , University of Athens , Athens , Greece. 3. c Department of Neurology , University of Tennessee Health Science Center , Memphis , TN , USA. 4. d International Clinical Research Center , St. Anne's University Hospital in Brno , Brno , Czech Republic. 5. e Stroke Unit , Metropolitan Hospital , Athens , Greece. 6. f Department of Neurology , St. Josef-Hospital , Bochum , Germany. 7. g Medical Faculty , Ruhr University , Bochum , Germany. 8. h Department of Neurosurgery , Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Science Center , Memphis , TN , USA.
Abstract
BACKGROUND: Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years. METHODS: Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published. RESULTS: These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6. CONCLUSIONS: The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for stroke patients.
BACKGROUND:Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years. METHODS: Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published. RESULTS: These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6. CONCLUSIONS: The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for strokepatients.
Authors: Konark Malhotra; Nitin Goyal; Aristeidis H Katsanos; Angeliki Filippatou; Eva A Mistry; Pooja Khatri; Mohammad Anadani; Alejandro M Spiotta; Else Charlotte Sandset; Amrou Sarraj; Georgios Magoufis; Christos Krogias; Lars Tönges; Apostolos Safouris; Lucas Elijovich; Mayank Goyal; Adam Arthur; Andrei V Alexandrov; Georgios Tsivgoulis Journal: Hypertension Date: 2020-01-13 Impact factor: 10.190
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Dimitris Mavridis; Anne W Alexandrov; Georgios Magoufis; Adam Arthur; Valeria Caso; Peter D Schellinger; Andrei V Alexandrov Journal: Ther Adv Neurol Disord Date: 2016-12-01 Impact factor: 6.570