Mahesh V Jayaraman1,2,3,4, Ryan A McTaggart5,6,7,8, Mayank Goyal9,10. 1. Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA. mahesh.jayaraman@gmail.com. 2. Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. mahesh.jayaraman@gmail.com. 3. Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. mahesh.jayaraman@gmail.com. 4. The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI, USA. mahesh.jayaraman@gmail.com. 5. Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA. 6. Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. 7. Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA. 8. The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI, USA. 9. Department of Radiology, University of Calgary School of Medicine, Foothills Medical Centre, Calgary, AB, Canada. 10. Clinical Neurosciences, University of Calgary School of Medicine, Foothills Medical Centre, Calgary, AB, Canada.
Abstract
PURPOSE OF REVIEW: Trials demonstrating marked benefit of mechanical thrombectomy (MT) for acute stroke caused by large vessel occlusion (LVO) in the anterior circulation have been the most significant advance in acute ischemic stroke in the past 20 years. However, despite this marked advance, there are still many hurdles to improving access to thrombectomy worldwide. Additionally, despite these advances, a substantial portion of patients with LVO still are left disabled. RECENT FINDINGS: The major randomized trials focused on patients within 6 h from symptom onset, with occlusion of the ICA or proximal MCA, small amount of permanently damaged brain, and a moderate to large clinical deficit. We will explore the role of thrombectomy outside of these areas, but also explore larger issues as they pertain to re-organization of stroke systems of care to improve access to this remarkable therapy. Now that we have proven, without a shadow of doubt, that rapid revascularization with mechanical thrombectomy improves outcomes in LVO stroke, we must reorganize our systems of care to improve access and assess the role for MT outside of the patients who meet trial criteria.
PURPOSE OF REVIEW: Trials demonstrating marked benefit of mechanical thrombectomy (MT) for acute stroke caused by large vessel occlusion (LVO) in the anterior circulation have been the most significant advance in acute ischemic stroke in the past 20 years. However, despite this marked advance, there are still many hurdles to improving access to thrombectomy worldwide. Additionally, despite these advances, a substantial portion of patients with LVO still are left disabled. RECENT FINDINGS: The major randomized trials focused on patients within 6 h from symptom onset, with occlusion of the ICA or proximal MCA, small amount of permanently damaged brain, and a moderate to large clinical deficit. We will explore the role of thrombectomy outside of these areas, but also explore larger issues as they pertain to re-organization of stroke systems of care to improve access to this remarkable therapy. Now that we have proven, without a shadow of doubt, that rapid revascularization with mechanical thrombectomy improves outcomes in LVO stroke, we must reorganize our systems of care to improve access and assess the role for MT outside of the patients who meet trial criteria.
Entities:
Keywords:
Large vessel occlusion; Mechanical thrombectomy; Neuroprotection; Stroke; Stroke systems of care
Authors: Matthias Wendt; Martin Ebinger; Alexander Kunz; Michal Rozanski; Carolin Waldschmidt; Joachim E Weber; Benjamin Winter; Peter M Koch; Erik Freitag; Jenrik Reich; Daniel Schremmer; Heinrich J Audebert Journal: Stroke Date: 2015-01-29 Impact factor: 7.914
Authors: Ryan A McTaggart; Eric L Tung; Shadi Yaghi; Shawna M Cutting; Morgan Hemendinger; Heather I Gale; Grayson L Baird; Richard A Haas; Mahesh V Jayaraman Journal: J Neurointerv Surg Date: 2016-12-16 Impact factor: 5.836
Authors: Mahesh V Jayaraman; Arshad Iqbal; Brian Silver; Matthew S Siket; Caryn Amedee; Ryan A McTaggart; Gino Paolucci; Jason Rhodes; John Potvin; Megan Tucker; Nicole Alexander-Scott Journal: J Neurointerv Surg Date: 2016-03-03 Impact factor: 5.836
Authors: Napasri Chaisinanunkul; Opeolu Adeoye; Roger J Lewis; James C Grotta; Joseph Broderick; Tudor G Jovin; Raul G Nogueira; Jordan J Elm; Todd Graves; Scott Berry; Kennedy R Lees; Andrew D Barreto; Jeffrey L Saver Journal: Stroke Date: 2015-07-02 Impact factor: 7.914
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Fabricio O Lima; Karen L Furie; Gisele S Silva; Michael H Lev; Erica C S Camargo; Aneesh B Singhal; Gordon J Harris; Elkan F Halpern; Walter J Koroshetz; Wade S Smith; Raul G Nogueira Journal: JAMA Neurol Date: 2014-02 Impact factor: 18.302
Authors: Bijen Nazliel; Sidney Starkman; David S Liebeskind; Bruce Ovbiagele; Doojin Kim; Nerses Sanossian; Latisha Ali; Brian Buck; Pablo Villablanca; Fernando Vinuela; Gary Duckwiler; Reza Jahan; Jeffrey L Saver Journal: Stroke Date: 2008-06-12 Impact factor: 7.914
Authors: Mohamed S Teleb; Anna Ver Hage; Jaqueline Carter; Mahesh V Jayaraman; Ryan A McTaggart Journal: J Neurointerv Surg Date: 2016-02-17 Impact factor: 5.836
Authors: Noémi Klára Tóth; Edina Gabriella Székely; Katalin Réka Czuriga-Kovács; Ferenc Sarkady; Orsolya Nagy; Levente István Lánczi; Ervin Berényi; Klára Fekete; István Fekete; László Csiba; Zsuzsa Bagoly Journal: Front Neurol Date: 2018-01-23 Impact factor: 4.003