Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients - A position paper endorsed by ESMINT and ESNR

Fiehler, Jens; Söderman, Michael; Turjman, Francis; White, Phil; Bakke, Søren Jacob; Mangiafico, Salvatore; Kummer, Ruediger von; Muto, Mario; Cognard, Christophe; Gralla, Jan

doi:10.1007/s00234-012-1076-y

Cited by 7 publications

(6 citation statements)

References 74 publications

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“…1 With technical advancements of mechanical thrombectomy, higher and more consistent rates of recanalization are achieved compared with intravenous (IV) therapy alone. However, endovascular treatment has not unequivocally translated into a measureable patient benefit in randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Kemmling

Flottmann

Forkert

et al. 2015

J Cereb Blood Flow Metab

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Benefit of endovascular recanalization beyond established treatment time windows likely exists in select stroke patients. However, there is currently no imaging model that predicts infarction adjusting for elapsed time between the pathologic snapshot of admission imaging until endovascular recanalization. We trained and cross validated a multivariate generalized linear model (GLM) that uses computer tomography perfusion and clinical data to quantify patient-specific dynamic change of tissue infarction depending on degree and time of recanalization. Multicenter data of 161 patients with proximal anterior circulation occlusion undergoing endovascular therapy were included. Multivariate voxelwise infarct probability was calculated within the GLM. The effect of increasing time to treatment and degree of recanalization on voxelwise infarction was calculated in each patient. Tissue benefit of successful relative to unsuccessful recanalization was shown up to 15 hours after onset in individual patients and decreased nonlinearly with time. On average, the relative reduction of infarct volume at the treatment interval of 5 hours was 53% and this salvage effect decreased by 5% units per hour to o 5% after 10 additional hours to treatment. Treatment time-adjusted multivariate prediction of infarction by perfusion and clinical status may identify patients who benefit from extended time to recanalization therapy.

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Section: Introductionmentioning

confidence: 99%

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Kemmling

Flottmann

Forkert

et al. 2015

J Cereb Blood Flow Metab

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“…Actualmente es tema de discusión el uso de sedación consciente versus anestesia general en los procedimientos de trombectomía mecánica (6) . En nuestra serie, el 95% de los procedimientos fueron realizados sin sedación consciente, ni anestesia general, incluyendo en ese 5% restante, a pacientes con compromiso de conciencia secundario a oclusión del territorio vertebro-basilar.…”

Section: Resultsunclassified

“…Para evitar el daño endotelial fijamos un máximo de tres pases de TREVO. Con respecto a este punto, en las últimas publicaciones se ha fijado un plazo arbitrario de cinco pases como límite (6) . En caso de lesiones en tándem de bifurcación carotídea, realizamos angioplastia con stent, para posteriormente, realizar la trombectomía.…”

Section: Métodosunclassified

Trombectomía Mecánica en el ICTUS: Experiencia con Trevo en Hospital Provincial Clínico Barcelona

O¹,

R²,

M³

et al. 2013

Rev. chil. radiol.

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IntroducciónLa eficacia clínica del tratamiento endovascular en el infarto cerebral isquémico agudo, no ha sido demostrada en estudios randomizados. En el transcurso de este último período, se han diseñado múltiples dispositivos de trombectomía mecánica con gran variabilidad de resultados en relación con el porcentaje de recanalización y efectos adversos. Con el presente estudio, pretendemos transmitir nuestra experiencia en el tratamiento endovascular de pacientes con infarto cerebral isquémico agudo, tratados con el dispositivo de trombectomía mecánica "stent-like" TREVO (Concentrical Medical Inc, Mountain View, CA). MétodosDesde enero del 2008 a diciembre del 2011, 145 casos consecutivos de pacientes con infarto cerebral isquémi-co agudo, fueron tratados con trombectomía mecánica con Trevo como único dispositivo "stent-like" (Figura 1). En 11 casos en que no logramos recanalización satisfactoria, complementamos el tratamiento endovascular mecánico con dispositivos de distinto diseño (Solitaire n6 Merci n3, Solitaire + Merci n1 o Factor recombinante activador del plasminógeno intraarterial (rTPa IA) n1). Los procedimientos fueron realizados por neurorradiólogos con más de 10 años de experiencia en procedimientos

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“…The combined stroke task force of two European societies of neuroradiologists/ neurointerventionists (ESNR-ESMINT) emphasized these issues prior to the publication of the results of the three trials [4,5]. The main weaknesses of these trials are: IA administration of fibrinolytics, as well as treatment with first-generation thrombectomy devices, has been replaced with stent-based thrombectomy devices.…”

Section: Discussionmentioning

confidence: 99%

“…The European Society of Minimally Invasive Neurological Therapy (ESMINT) and European Society of Neuroradiology (ESNR) represent the interventional neuroradiology community in Europe and have engaged in the definition of rules regarding trials evaluating the EVT of AIS [4,5]. It is clearly their role to provide a precise analysis of recent and future trials.…”

Section: Introductionmentioning

confidence: 99%

Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke

et al. 2013

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Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients - A position paper endorsed by ESMINT and ESNR

Cited by 7 publications

References 74 publications

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Multivariate Dynamic Prediction of Ischemic Infarction and Tissue Salvage as a Function of Time and Degree of Recanalization

Trombectomía Mecánica en el ICTUS: Experiencia con Trevo en Hospital Provincial Clínico Barcelona

Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke

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