Primary Intracranial Stenting in Acute Ischemic Stroke

Velat, Gregory J.; Hoh, Brian L.; Levy, Elad I.; Mocco, J

doi:10.1007/s11886-009-0069-x

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…Self-expanding stents for cerebral use have advantages over balloon angioplasty as they can be delivered to the target vessel with reduced barotrauma, thereby decreasing the risk of rupturing or dissecting the cerebral vessel 29. Moreover, they adapt much better to the shape and anatomy of the affected artery.…”

Section: Stent-based Thrombectomymentioning

confidence: 99%

Management of ischaemic stroke in the acute setting : review of the current status : review article

Jivan

Ranchod

Modi

2013

CVJA

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Acute ischaemic stroke can be treated by clot busting and clot removal. Thrombolysis using intravenous recombinant-tissue plasminogen activator (IV r-TPA) is the current gold standard for the treatment of acute ischaemic stroke (AIS). The main failure of this type of treatment is the short time interval from stroke onset within which it has to be used for any benefit. The evidence is that IV r-TPA has to be used within 4.5 hours.Other modalities of treatment are not as effective and need more scrutiny and examination. The available modalities are intra-arterial thrombolysis and clot-retrieval devices. Not unexpectedly, recanalisation treatments have flourished at a rapid rate. Although vessel recanalisation is vital to increasing the possibility of significant tissue reperfusion, clinical trials need to emphasise functional outcomes rather than reperfusion/recanalisation rates to adequately assess success of these devices/techniques.Our view is that until these treatments become proven in large-scale studies, a greater endeavour should be made in resource-limited settings to expand facilities to enable intravenous r-tPA treatment within the 4.5-hour period following onset of stroke. The resources required are small with the main costs being a CT scan of the brain and the cost of r-tPA. This can easily be done in any emergency facility in any part of the world. What is needed is public awareness, and campaigns of ‘stroke attack’ should be revisited, especially in the resource-limited context. This approach at present will halt to some extent the stroke pandemic that we are facing.

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Section: Stent-based Thrombectomymentioning

confidence: 99%

Management of ischaemic stroke in the acute setting : review of the current status : review article

Jivan

Ranchod

Modi

2013

CVJA

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“…Intracranial arteries are more prone to vessel dissection and a ‘snow plough’ effect in which plaque displaced by the stent piles up and occludes the ostium of perforator vessels. Self‐expanding stents are better suited to cerebral use: they can be delivered to the target vessel with reduced barotrauma and they adapt more fully to the shape and anatomy of the affected artery [83]. In a 20 patients, single centre, uncontrolled trial of the Wingspan self expanding stent, partial or better recanalisation was achieved in 100% and complete recanalisation in 60% of acute cerebral ischaemia patients [84].…”

Section: Endovascular Mechanical Therapiesmentioning

confidence: 99%

Improving reperfusion therapy for acute ischaemic stroke

Saver

2011

Journal of Thrombosis and Haemostasis

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Summary. Background: The first generation of clinical reperfusion treatment, intravenous (IV) fibrinolysis with tissue plasminogen activator (tPA), was a transformative breakthrough in stroke care, but is far from ideal. Objectives: To survey emerging strategies to increase the efficacy and safety of cerebral reperfusion therapy. Methods: Narrative review. Results and Conclusions: Innovative IV pharmacologic reperfusion strategies include: extending IV tPA use to patients with mild deficits; developing novel fibrinolytic agents (tenecteplase, desmetolplase, plasmin); using ultrasound to enhance enzymatic fibrinolysis; combination clot lysis therapies (fibrinolytics with GPIIb/IIIa agents or direct thrombin inhibitors); co‐administration of MMP‐9 inhibitors to deter haemorrhagic transformation; and prehospital neuroprotection to support threatened tissues until reperfusion. Endovascular recanalisation strategies are rapidly evolving, and include intra‐arterial fibrinolysis, mechanical clot retrieval, suction thrombectomy, and primary stenting. Combined approaches appear especially promising, using IV fibrinolysis to rapidly initiate reperfusion, mechanical endovascular treatment to debulk large, proximal thrombi, and intra‐arterial (IA) fibrinolysis to clear residual distal thrombus elements and emboli.

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“…Stroke is the third leading cause of death in the United States; approximately 795,000 Americans experience a new or recurrent stroke each year, with more than two-thirds of cases representing the first instance of the disease. Since 2009, the direct and indirect economic burdens due to stroke have been estimated at 6.89 billion US dollars [1] . China also has a high incidence of stroke-the second highest in the world.…”

Section: Introductionmentioning

confidence: 99%

Advances in research of intracranial vascular stent

Zhang²,

Jiang

et al. 2017

Transl. Neurosci. Clin.

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KEYWORDSstroke; intracranial stent; classification; structure and preparation; performance indexIn recent years, China's population has shown an obvious aging trend. This trend has been accompanied by an increased incidence of cardiovascular disease and death.Intracranial stenting has become an important treatment modality for intracranial vascular disease because it is effective, safe, and widely approved. In this paper, we review the literature concerning the classification, structure, preparation, and performance of intracranial stents. We also summarize problems and future prospects in the context of intracranial stents. This paper will serve as a reference for the future research and development of intracranial stents.

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Primary Intracranial Stenting in Acute Ischemic Stroke

Cited by 8 publications

References 28 publications

Management of ischaemic stroke in the acute setting : review of the current status : review article

Management of ischaemic stroke in the acute setting : review of the current status : review article

Improving reperfusion therapy for acute ischaemic stroke

Advances in research of intracranial vascular stent

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