Endovascular thrombectomy for the treatment of acute ischemic stroke

Abstract

Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms

“…The introduction of stent retrieval to treat ischemic stroke enables a rapid and reliable extraction of the thrombus 2,8 . It allows an effective encapsulation of the thrombus (Figure 3), restoration of blood flow and potentiation of thrombolytic substances 19 . Furthermore, modern devices permit faster access and easier navigation due to a more flexible profile 20 .…”

“…Furthermore, modern devices permit faster access and easier navigation due to a more flexible profile 20 . Recent prospective trials have shown the clinical benefit of endovascular therapy, providing high-level evidence that has changed the guidelines of acute stroke therapy to recommend endovascular therapy with a stent retriever over intra-arterial fibrinolysis alone as first-line therapy 10,19,20,21 . However, its use during transprocedural thromboembolic events is still not validated, as the passage of the device over the coil mass could displace it and occlude the parent vessel.…”

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

“…Recently, endovascular treatment has been shown to improve functional outcome in five randomized clinical trials of selected patients with AIS associated with PAO of the anterior circulation 2, 3,4,5,6,7 . A summary of core design features and results is presented in the Table.…”

A comparative study of Danhong injection and Salvia miltiorrhiza injection in the treatment of cerebral infarction

“…Among western medicine (WM) therapies, recent studies demonstrated that intravenous thrombolysis and endovascular thrombectomy have good effect on treating cerebral infarction; however, time window, correct diagnosis, anesthesia, treatment cost, and such problems need to be considered in the process of treatment, which may influence the desired effect. [6–8] Then, the therapeutic practice of activating blood circulation for removing blood stasis of TCM holds a significant position for the treatment of cerebral infarction. [9] In addition, Chinese herbal injections (CHIs) own the features of remarkable curative efficiency, rapid action, and high bioavailability.…”