Acute Stroke Therapy 1981–2009*

Abstract

This article includes a review of major intravenous and endovascular stroke trials, treatment options, and future aspects of acute stroke treatment in hemispheric and vertebrobasilar stroke. Since the invention of local intraarterial thrombolysis by Hermann Zeumer in 1981, acute stroke diagnostics and treatment have undergone dramatic improvement. This article addresses major topics in recent stroke treatment debates: optimization of patient selection, intravenous versus endovascular therapy, time window limitations, combined treatment with intravenous/intraarterial bridging therapies (intravenous/intraarterial recombinant tissue plasminogen activator [rtPA] bridging and intravenous glycoprotein IIb/IIIa inhibitor/intraarterial rtPA bridging) and modern endovascular treatment modes like percutaneous transluminal angioplasty (PTA)/stenting and mechanical thrombectomy devices. Modern acute stroke therapy networks should optimize their noninvasive diagnostic capacity to early identify candidates for endovascular therapy with rapid access to specialized neuroendovascular centers using standard protocols. The most promising approach in acute stroke treatment seems to be a combination of intravenous and endovascular revascularization procedure, combining early treatment initiation with direct clot manipulation and PTA/stenting in underlying stenosis with atherothrombotic occlusions. Further randomized studies comparing intravenous and endovascular treatment, mainly in the anterior circulation, have to be expected and need wide support of the neurologic and neuroradiologic stroke community.

Decomposing the Hounsfield Unit

“…The prompt and correct stratification of stroke patients is decisive for the choice of the optimal therapy [22,23]. For acute stroke however numerous studies revealed inadequate interpretation of brain ct scans by acute care physicians [24,25] and even by experienced clinicians [26].…”

Neuroendovascular Treatments/Procedures

“…TIMI grades 2Y3 are pertinent in that revascularization is essential to achieve good outcomes. The modern stroke imaging using multimodal magnetic resonance imaging (MRI) and CT that provide information on occlusion type, penumbral tissue, and unsalvageable infarct core, which are an integral part of the standard of care, were not available at the seven hospitals involved, so this information was not available for analysis (Eckert, 2009;Tarr et al, 2010). However, the above study was limited for the following reasons.…”

Notoginseng Leaf Triterpenes Ameliorates OGD/R-Induced Neuronal Injury via SIRT1/2/3-Foxo3a-MnSOD/PGC-1α Signaling Pathways Mediated by the NAMPT-NAD Pathway

“…Cerebral ischemic stroke (CIS) is one of the leading causes of death worldwide; it has the characteristics of high morbidity, lethality, disability, and recurrence rate [ 1 – 3 ]. The related researches and reports have revealed that cerebral ischemia and reperfusion (I/R) injury (CIRI) is involved in energy metabolism disorders [ 4 ], oxidative stress [ 5 ], Ca 2+ overload, excitatory neurotransmitters, apoptosis, and necrosis [ 5 ].…”

“…Ischemic stroke is a complex pathological process with multiple mechanisms [ 1 – 3 ]. Many pharmacological agents have been investigated for years, though with limited clinical success.…”