Mechanical thrombectomy – is time still brain? The DAWN of a new era

Kamal, Naveed; Majmundar, Neil; Damadora, Nitesh; El‐Ghanem, Mohammad; Nuoman, Rolla; Keller, Irwin; Schonfeld, Steven; Rybinnik, Igor; Gupta, Gaurav; Roychowdry, Sudipta; Al‐Mufti, Fawaz

doi:10.1080/02688697.2018.1426726

Cited by 10 publications

(12 citation statements)

References 64 publications

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“…31 Seners et al indicated that the likelihood of early neurologic deterioration is correlated with more proximal and longer clot lengths, potentially allowing selection for EVT of those patients more like to Figure 1 The NNT for major RCTs of mechanical thrombectomy and other key medical therapies. 5 (A) Illustrating the NNT for seven RCTs. (B) The NNT for key medical therapies including decompressive haemicraniectomy for MCA infarction, defibrillation for cardiac arrest, thrombectomy for AIS (the DAWN Trial), goal-directed therapy for acute sepsis, thrombolysis for AIS <3 hours, ipratropium and beta-agonist nebulizer for childhood asthma, thrombolysis for AIS >3 hours and <4.5 hours, PCI for highrisk ST-elevation myocardial infarction, aspirin for ST-elevation myocardial infarction, antibiotics for the primary prevention of rheumatic fever and bariatric surgery on mortality in obese patients.…”

Section: Mild Strokesmentioning

confidence: 99%

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Guo

Miao²

2021

Stroke Vasc Neurol

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Advances in endovascular treatment of acute ischaemic stroke from intracranial large vessel occlusions have continued in the past decade. Here, we performed a detailed review of all the new trials and studies that had the highest evidence, the guidelines for mechanical thrombectomy, the selection of the particular population outside the guidelines and endovascular therapeutic strategies for acute ischemic stroke from occluded intracranial arteries.

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Section: Mild Strokesmentioning

confidence: 99%

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Guo

Miao²

2021

Stroke Vasc Neurol

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“…Recently published trials have demonstrated the safety and efficacy of endovascular treatment up to 6 h after the onset of IS [9][10][11][12][13][14]. In addition, a new generation of randomized controlled clinical trials with specific selection criteria based on patient characteristics has made it possible to extend the time window in which it is possible to treat patients with IS due to occlusion of proximal anterior circulation vessels with thrombectomy (16-24 h) [15][16][17][18]. However, due to the restricted eligibility criteria [19] for patients to receive these treatments, many stroke patients do not receive active therapies.…”

Section: Introductionmentioning

confidence: 99%

Different Roles of Mitochondria in Cell Death and Inflammation: Focusing on Mitochondrial Quality Control in Ischemic Stroke and Reperfusion

et al. 2021

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Mitochondrial dysfunctions are among the main hallmarks of several brain diseases, including ischemic stroke. An insufficient supply of oxygen and glucose in brain cells, primarily neurons, triggers a cascade of events in which mitochondria are the leading characters. Mitochondrial calcium overload, reactive oxygen species (ROS) overproduction, mitochondrial permeability transition pore (mPTP) opening, and damage-associated molecular pattern (DAMP) release place mitochondria in the center of an intricate series of chance interactions. Depending on the degree to which mitochondria are affected, they promote different pathways, ranging from inflammatory response pathways to cell death pathways. In this review, we will explore the principal mitochondrial molecular mechanisms compromised during ischemic and reperfusion injury, and we will delineate potential neuroprotective strategies targeting mitochondrial dysfunction and mitochondrial homeostasis.

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“…We calculated an overall NNT of 3.6, which indicates superiority over other treatments and procedures (e.g., intravenous thrombolysis performed within 3 hours from symptom onset produced an NNT of 8). 10 In light of these findings, the therapeutic window for endovascular procedures could be extended up to 24 hours. However, our pooled analysis revealed that the main benefits resulted in the last two trials that applied stricter inclusion and exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy in Strokes with Large-Vessel Occlusion Beyond 6 Hours: A Pooled Analysis of Randomized Trials

et al. 2018

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Background and PurposeMechanical thrombectomy with or without intravenous thrombolysis is indicated in the acute treatment of ischemic strokes caused by an emergent large-vessel occlusion (ELVO) within 6 hours from symptom onset. However, a significant proportion of patients are referred to comprehensive stroke centers beyond this therapeutic time window. This study performed a pooled analysis of data from trials in which mechanical thrombectomy was performed beyond 6 hours from symptom onset.MethodsWe searched for randomized controlled trials that compared mechanical thrombectomy with the best medical treatment beyond 6 hours for ischemic strokes due to ELVO and reported on between 1990 and April 2018. The intervention group comprised patients treated with mechanical thrombectomy. Statistical analysis was conducted while pooling data and analyzing fixed- or random-effects models as appropriate.ResultsFour trials involving 518 stroke patients met the eligibility criteria. There were 267 strokes treated with mechanical thrombectomy, with a median time of 10.8 hours between when the patient was last known to be well to randomization. We observed a significant difference between groups concerning the rate of functional independence at 90 days from stroke, with an absolute difference of 27.5% (odds ratio=3.33, 95% CI=1.81–6.12, p<0.001) and good recanalization (odds ratio=13.17, 95% CI=4.17–41.60, p<0.001) favoring the intervention group.ConclusionsThis meta-analysis confirms the efficacy of mechanical thrombectomy in selected ischemic stroke patients beyond 6 hours from symptom onset. The selection is mainly based on the limited core infarct detected by emergent assessment using neuroimaging techniques.

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Mechanical thrombectomy – is time still brain? The DAWN of a new era

Abstract: The advancement of endovascular treatment for stroke has led to improved morbidity and mortality for patients. Future challenges include delivering these treatments to stroke centers worldwide.

Cited by 10 publications

References 64 publications

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

Different Roles of Mitochondria in Cell Death and Inflammation: Focusing on Mitochondrial Quality Control in Ischemic Stroke and Reperfusion

Mechanical Thrombectomy in Strokes with Large-Vessel Occlusion Beyond 6 Hours: A Pooled Analysis of Randomized Trials

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