Reperfusion therapy in acute ischemic stroke: dawn of a new era?

Bhaskar, Sonu; Stanwell, Peter; Cordato, Dennis; Attia, John; Levi, Christopher

doi:10.1186/s12883-017-1007-y

Cited by 187 publications

(156 citation statements)

References 275 publications

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“…We analyzed interventions from 2014 to 2018. In this period, major improvements of material and methods were made [15]. We found a peak of failing interventions in the year 2015 with many recanalization results of mTICI 2a.…”

Section: Discussionmentioning

confidence: 87%

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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Purpose Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. Methods Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment.Results One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success.The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. Conclusion In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases.In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.

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Section: Discussionmentioning

confidence: 87%

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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“…The impact of stroke is devastating due to the loss of health-related quality of life and the overall burden of disease costs amounting to $A49.2 billion 1. During the past 15 years, advances in acute stroke therapies, in particular, reperfusion therapy, such as intravenous thrombolysis and more recently endovascular thrombectomy, has seen a significant increase in the proportion of acute ischaemic stroke patients who are functionally independent 2. Initiatives and programmes to promote awareness about the benefits of early presentation is key for delivering improved value care to stroke patients 3–12.…”

Section: Introductionmentioning

confidence: 99%

Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services

Bhaskar

Thomas

Cheng

et al. 2019

Postgraduate Medical Journal

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Background and purposeSouth Western Sydney comprises of a culturally and linguistically diverse (CALD) and lower socioeconomic status population group within the state of New South Wales. Geographic location and sociodemographic factors play important roles in access to healthcare and may be crucial in the success of time-critical acute stroke intervention. The aim of this study was to examine the trends in the delayed presentation to emergency department (ED) and identify factors associated with prehospital delay for an acute stroke/transient ischaemic attack (TIA) at a comprehensive stroke centre.MethodsPatient health-related data were extracted for stroke/TIA discharges for the period 2009–2017. Electronic medical record data were used to determine sociodemographic characteristics and prehospital factors, and their associations with delayed presentation≥4.5 hours from stroke onset were studied.ResultsDuring the 9-year period, population-adjusted stroke/TIA discharge rates increased from 540 to 676 per 100 000. A significant reduction in the proportion of patients presenting to ED<4.5 hours (56% in 2009 versus 46% in 2017, p<0.001) was observed. Younger patients aged 55–64 and 65–74 years, those belonging to Polynesia, South Asia and Mainland Southeast Asia, and those not using state ambulance as the mode of arrival to the hospital were at increased risk of prehospital delay.ConclusionsComprehensive reappraisal of educational programmes for early stroke recognition is required in our region due to delayed ED presentations of younger and specific CALD communities of stroke/TIA patients.

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“…Osoby, które były leczone tylko trombolitycznie miały lepsze wyniki w testach sprawności i miały mniejszy stopień niepełnosprawności niż osoby leczone trombolitycznie i trombektomią. (PNN 2019;8(2):69-77) Słowa kluczowe: udar mózgu, tromboliza, trombektonia, funkcjonowanie procedure using a microcatheter and other thrombectomy devices to stop and remove a blood clot from a blocked artery [9,11]. The radiologist removes the thrombus with a special catheter.…”

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Endovascular and Thrombolytic Therapy and the Functional Status of Patients after Ischemic Stroke

Jabłońska

Wronkowska

Ślusarz

et al. 2019

PNIN

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Introduction. Stroke is treated as a direct threat to life. Mechanical thrombectomy used as an independent treatment or in combination with systemic thrombolysis is currently the standard care in the treatment of ischemic stroke. Aim. Evaluation of the functional status of patients after ischemic stroke treated with thrombolysis or thrombectomy. Material and Methods. The study involved 50 patients hospitalized due to ischemic stroke. Standardized research tools were used: the Rankin scale, the Barthel scale and the Functional Index "Repty" (WFR). The study was conducted twice in one patient: on the first and ninth day after the treatment. The collected material was developed statistically. Results. Most of the respondents were men-62%. Thrombolytic treatment was used in all subjects, and thrombectomy in 26% people. Analyses showed that there were differences in the Barthel scale level Z = 4.87; p < 0.001, Rankin Z = 4.80; p < 0.001 and WFR Z = 4.83; p < 0.001. The age of the respondents was related negatively to the Barthel scale score on the 1 st day ρ =-0.51; p < 0.001 and the 9 th day ρ =-0.53; p < 0.001 and the result in the WFR scale on the 1 st day ρ =-0.54; p < 0.001 and the 9 th day ρ =-0.52; p < 0.001. Conclusions. The performance of the subjects on the 1st day of treatment was worse than on the 9th day. People who were only treated with thrombolysis had better results in fitness tests and had a lower level of disability than people treated with thrombolysis and thrombectomy.

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Reperfusion therapy in acute ischemic stroke: dawn of a new era?

Cited by 187 publications

References 275 publications

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Trends in acute stroke presentations to an emergency department: implications for specific communities in accessing acute stroke care services

Endovascular and Thrombolytic Therapy and the Functional Status of Patients after Ischemic Stroke

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