Tasneem F Hasan1, Nathaniel Todnem2, Neethu Gopal3, David A Miller4, Sukhwinder S Sandhu3, Josephine F Huang5, Rabih G Tawk6. 1. Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA, USA. 2. Department of Neurologic Surgery, Medical College of Georgia, Augusta, Georgia. 3. Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. 4. Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL, USA. 5. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. 6. Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. Tawk.Rabih@mayo.edu.
Abstract
PURPOSE OF REVIEW: To review the current evidence supporting the use of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO). RECENT FINDINGS: Recent advances in AIS management by EVT have led to significant reduction in morbidity and mortality in selected patients with LVO within the anterior circulation. Until recently, use of EVT was strictly based on time criteria, within 4.5 to 12 h of symptom onset with many patients presenting with "wake-up" stroke who were not considered for EVT. The positive results of the DAWN and DEFUSE-3 trials have shown benefit in extending the therapeutic window for EVT to 24 and 16 h, respectively, after last known normal (LKN) time in the setting of large ischemic penumbra. These trials represent a paradigm shift in contemporary treatment of AIS, changing from a purely time-based decision to treat to an individualized decision based on clinical and radiographic findings of salvageable tissue. Overall, acute stroke management has evolved considerably over the years from intravenous thrombolysis to include EVT, with paralleled improvements in patient selection and thrombectomy devices. Since the results of the DAWN and DEFUSE-3, EVT is now considered the standard of care in select patients with anterior circulation LVO up to 24 h from LKN time. Despite these developments, post-stroke disability remains pervasive and further studies are warranted in establishing the role of EVT in posterior circulation and distal vessel occlusions, with need for development of new and effective techniques for revascularization of small vessels.
PURPOSE OF REVIEW: To review the current evidence supporting the use of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO). RECENT FINDINGS: Recent advances in AIS management by EVT have led to significant reduction in morbidity and mortality in selected patients with LVO within the anterior circulation. Until recently, use of EVT was strictly based on time criteria, within 4.5 to 12 h of symptom onset with many patients presenting with "wake-up" stroke who were not considered for EVT. The positive results of the DAWN and DEFUSE-3 trials have shown benefit in extending the therapeutic window for EVT to 24 and 16 h, respectively, after last known normal (LKN) time in the setting of large ischemic penumbra. These trials represent a paradigm shift in contemporary treatment of AIS, changing from a purely time-based decision to treat to an individualized decision based on clinical and radiographic findings of salvageable tissue. Overall, acute stroke management has evolved considerably over the years from intravenous thrombolysis to include EVT, with paralleled improvements in patient selection and thrombectomy devices. Since the results of the DAWN and DEFUSE-3, EVT is now considered the standard of care in select patients with anterior circulation LVO up to 24 h from LKN time. Despite these developments, post-stroke disability remains pervasive and further studies are warranted in establishing the role of EVT in posterior circulation and distal vessel occlusions, with need for development of new and effective techniques for revascularization of small vessels.
Authors: Mustapha A Ezzeddine; Michael H Lev; Colin T McDonald; Guy Rordorf; Jamary Oliveira-Filho; Fatma Gul Aksoy; Jeffrey Farkas; Alan Z Segal; Lee H Schwamm; R Gilberto Gonzalez; Walter J Koroshetz Journal: Stroke Date: 2002-04 Impact factor: 7.914
Authors: Stephan P Kloska; Darius G Nabavi; Christiane Gaus; Eun-Mi Nam; Ernst Klotz; E Bernd Ringelstein; Walter Heindel Journal: Radiology Date: 2004-08-31 Impact factor: 11.105