Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

Lodi, Y; Reddy, Varun; Petro, George R.; Devasenapathy, Ashok; Hourani, Anas; Chou, Chun-An

doi:10.1136/neurintsurg-2015-012172

Cited by 2 publications

(3 citation statements)

References 18 publications

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“…Lodi et al reported that primary stent retriever thrombectomy within three hours without IV thrombolysis in acute ischemic stroke from larger vessel occlusion with a high NIHSS score (!10) is associated with efficient recanalization in all cases and good outcomes. 19 These findings showed that early initiation of endovascular therapy resulted in early recanalization, which might have been reflected in good functional outcome. 19 Three hours after stroke onset can be one of the important time indices in endovascular thrombectomy.…”

Section: Discussionmentioning

confidence: 77%

“…19 These findings showed that early initiation of endovascular therapy resulted in early recanalization, which might have been reflected in good functional outcome. 19 Three hours after stroke onset can be one of the important time indices in endovascular thrombectomy. In-hospital workflow should be designed so as to deliver patients with ALVO with an OTP <3 h to the angiography suite for the start of treatment.…”

Section: Discussionmentioning

confidence: 77%

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Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

et al. 2017

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Introduction Endovascular treatment for acute ischemic stroke with acute large-vessel occlusion (ALVO) has established benefits, and rapid treatment is vital for mechanical thrombectomy in ALVO. Time from onset of stroke to groin puncture (OTP) is a practical and useful clinical marker, and OTP should be shortened to obtain the maximum benefit of thrombectomy. Objective The aim of the present study was to assess the impact of early treatment of anterior circulation stroke within three hours after symptom onset and to evaluate the role of OTP in determining outcomes after endovascular therapy. Methods Consecutive patients with acute stroke due to major artery (internal carotid or middle cerebral arteries) occlusion who underwent endovascular recanalization between March 2014 and January 2017 were retrospectively evaluated. Patients were stratified by OTP into three categories: 0–≤3 h, >3–≤6 h, and >6 h. The primary outcome measure was a 90-day modified Rankin scale score of 0–2 (good outcome). Results Data were analyzed from 100 patients (mean age, 76.6 years; mean National Institutes of Health Stroke Scale score, 17). Groin puncture occurred within 0–≤3 h in 51 patients, >3–≤6 h in 28, and >6 h in 21. Median OTP in each group was 126 min (range, 57–168 min), 238 min (range, 186–360 min) and 728 min (range, 365–1492 min), respectively. On multivariable logistic regression analysis, category of OTP represented an independent predictor of patient outcome (adjusted odds ratio, 0.48; 95% confidence interval, 0.25–0.93; p = 0.029). Conclusions OTP is a prehospital and in-hospital workflow-based indicator. In this single-center study, OTP was found to independently affect functional outcomes after endovascular stroke treatment.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 77%

Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

et al. 2017

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“…After reviewing the risk and benefit including cost and most current evidence, 26,27 patient wanted EVMT without thrombolytic. Additionally, author had a pilot trial 28 of primary EVMT without IV tPA that demonstrated similar results of the most recent RCT. 26,27 Patient was told that the chances of complete perfusion may be less if no tPA is chosen, but, there were no differences in outcomes.…”

Section: Review Of Literature Using Real Casesmentioning

confidence: 78%

Simple and Swift Acute Ischemic Stroke Therapy based on Cases and Evidence: Possibilities of Cost Reduction and Improving Global Access

Lodi

Soltani

2023

MRAJ

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There have been significant improvement in the care of acute ischemic stroke (AIS) resulting in reducing death and improving outcomes. Numerous groundbreaking positive randomized controlled trials have demonstrated that strokes with large vessel occlusion (LVO) treated with endovascular mechanical thrombectomy (EVMT) with standard treatment are associated with much better outcomes compared to those treated only with standard therapy. Additional evidence also revealed that the positive outcomes continue to persists for stroke patients with large vessels occlusion if they are treated with 24 hours of symptoms including those with wake-up stroke. The evidence suggests that for every two-patient treated with EVMT, one patient can be saved, which is the highest evidence in the medicine surpassing acute myocardial infarction and other acute lifesaving therapies. Based on these evidence, the local, National and International organizations have updated the guidelines in the treatment of AIS which have remarkably strengthen the process, pathways and standards for acute ischemic stroke management in the developed countries. However, not much progresses have made in the developing and third-world countries for stroke therapies, because of cost, affordability and there are no third-party payers. Most recent trials have further discovered that stroke patient with LVO and a large core volume treated with endovascular perfusion therapy in conjunction with standard treatment do significantly better comparted to standard treatment alone. New trials have also demonstrated that stroke patients undergoing EVMT with or without thrombolytic have equal functional outcome. Additional evidence suggests that non-disabling stroke patients treated with dual antiplatelet have equal functional outcome with less bleeding risk compared to intravenous thrombolysis. These evolving evidences have provided us with the opportunities to simplify the algorithm and treatment of acute ischemic stroke, which not only will cutdown time by eliminating unnecessary steps and redundant therapies, but also will reduce the healthcare cost and improving global access, specially, countries where patients bear the costs. In this review, author presents real life stroke patients treated based on recent evidence and provides with a simple and swift algorithm, that will reduce time to perfusion therapy and will make treatment affordable globally.

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Primary acute stroke thrombectomy within 3 h for large artery occlusion (PAST3-LAO): a pilot study

Abstract: Our study demonstrates that primary SRT in AIS from LAO is safe and feasible and is associated with complete recanalization and good outcome. Further study is required.

Cited by 2 publications

References 18 publications

Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion

Simple and Swift Acute Ischemic Stroke Therapy based on Cases and Evidence: Possibilities of Cost Reduction and Improving Global Access

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