Journal Article10.1177/1747493015607503
Magnetic resonance imaging-based endovascular versus medical stroke treatment for symptom onset up to 12 h.
Anke Wouters,Robin Lemmens,Soren Christensen,Guido Wilms,Patrick Dupont,Michael Mlynash,Armin Schneider,Rico Laage,Carlo W. Cereda,Maarten G Lansberg,Gregory W. Albers,Vincent Thijs +11 more
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TL;DR: This indirect comparison suggests that endovascular treatment resulting in substantial reperfusion is associated with improved outcome in target mismatch patients even beyond 6 h after stroke onset.
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Abstract: BackgroundRecent trials have shown a clear benefit of endovascular therapy for stroke patients presenting within 6 h after stroke onset. Imaging-based selection may identify a cohort with a favorable response to endovascular therapy, in an even later time window.AimsWe performed an indirect comparison between outcomes seen in DEFUSE 2, a prospective cohort study of patients who received a baseline MRI before endovascular therapy, and a control group from AXIS 2 receiving standard medical care up to 12 h after symptom onset.MethodsPatients from AXIS 2 with a confirmed large vessel occlusion were selected as a control group for DEFUSE 2-patients. The primary endpoint was good functional outcome at day 90 (Modified Rankin Score 0–2). We performed a stratified analysis based on the presence of the target mismatch for both studies and reperfusion status in DEFUSE 2.ResultsWe compared good functional outcome in 108 patients from AXIS 2 and 99 patients from DEFUSE 2. In DEFUSE 2-patients with the target mismatch...
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Citations
Apparent Diffusion Coefficient Signal Intensity Ratio Predicts the Effect of Revascularization on Ischemic Cerebral Edema.
Matthew B. Bevers,Thomas W.K. Battey,Ann Christin Ostwaldt,Reza Jahan,Jeffrey L. Saver,W. Taylor Kimberly,Chelsea S. Kidwell +6 more
TL;DR: This study reaffirms the association of ADCr with outcome after stroke, supports the idea that reperfusion may attenuate rather than enhance post-stroke edema, and indicates that the degree of edema with and without revascularization may be predicted by ADCr.
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Current evidence for endovascular therapy in stroke and remaining uncertainties.
Ronan Motyer,Ronan Motyer,Hamed Asadi,John Thornton,John Thornton,Patrick Nicholson,Patrick Nicholson,Hong Kuan Kok,Hong Kuan Kok +8 more
TL;DR: Class 1 level A evidence now supports endovascular thrombectomy as best practice in the management of large vessel occlusion acute ischaemic stroke, and evidence suggests that a transition from time‐based to tissue‐based therapeutic thresholds may be of greater value.
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Efficacy and Safety of Endovascular Thrombectomy for Ischemic Stroke in Nonagenarians.
TL;DR: By using MRI-based selection, endovascular thrombectomy in nonagenarians with AIS caused by LVO within anterior circulation was safe and may lead to improve early neurologic recovery and functional independence at 90 days, as compared with IVT alone.
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A Meta-Analysis of Observational Evidence for the Use of Endovascular Thrombectomy in Proximal Occlusive Stroke Beyond 6 Hours in Patients with Limited Core Infarct.
James Wareham,Kevin Phan,Shelley Renowden,Alex Mortimer +3 more
- 05 Sep 2017
TL;DR: When compared to established methods of patient selection, EVT employed beyond 6 hours in those selected with imaging to exclude large core infarcts achieves similar rates of recanalization, and functional outcome but there is a significant increase in mortality despite no increase in symptomatic intracranial hemorrhage.
Neuroimaging in Randomized, Multi-Center Clinical Trials of Endovascular Treatment for Acute Ischemic Stroke: A Systematic Review.
Chong Hyun Suh,Seung Chai Jung,Byungjun Kim,Se Jin Cho,Dong Cheol Woo,Woo Yong Oh,Jong Gu Lee,Kyung Won Kim,Kyung Won Kim +8 more
TL;DR: This systematic review of the use of neuroimaging in recent randomized clinical trials for endovascular treatment of acute ischemic stroke will help researchers select appropriate imaging biomarkers among the various imaging protocols available and apply the selected type of imaging examination for each study in accordance with the academic purpose.
References
A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
Debbie Beumer,Debbie Beumer,Julie Staals,Jeannette Hofmeijer,Jelis Boiten,J. De Vries,Omid S. Eshghi,Koos Keizer,R. van den Berg,A. van der Lugt,Abstr Act +10 more
TL;DR: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe.
Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke
Mayank Goyal,Muneer Eesa,John Thornton,Denis-Claude Roy,Dar Dowlatshahi,Ashfaq Shuaib,D. Tampieri,David Williams,H. Choe,Brian T. Jankowitz,Michael Kelly,Guillermo Linares,Jai Jai Shiva Shankar,Alain Weill,Suresh Subramaniam,Abstr Act +15 more
TL;DR: In this paper, the authors evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation.
Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection
Bruce C.V. Campbell,Leonid Churilov,Nawaf Yassi,Bernard Yan,M. Brooks,F. Miteff,Martin Krause,M. Priglinger,Timothy Ang,Rebecca Scroop,Ben McGuinness,Tissa Wijeratne,Winston Chong,Monica S Badve,H. Rice,L. de Villiers,Henry Ma,Abstr Act +17 more
TL;DR: In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging, early thrombectomy with the Solitaire FR stent retriever, as compared with alteplase alone, improved reperfusion, early neurologic recovery, and functional outcome.
Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke
Jeffrey L. Saver,Mayank Goyal,Alain Bonafe,Hans-Christoph Diener,Elad I. Levy,Vitor Mendes Pereira,Gregory W. Albers,Christophe Cognard,David J. Cohen,Werner Hacke,Olav Jansen,Tudor G Jovin,Heinrich Mattle,Raul G Nogueira,Adnan H. Siddiqui,Dileep R. Yavagal,Blaise Baxter,Thomas Devlin,Demetrius K. Lopes,Vivek Y. Reddy,Richard du Mesnil de Rochemont,Oliver C. Singer,Reza Jahan +22 more
TL;DR: In patients receiving intravenous t-PA for acute ischemic stroke, thrombectomy with the use of a stent retriever within 6 hours after onset improved functional outcomes at 90 days.
Thrombectomy within 8 hours after symptom onset in ischemic stroke
A. Chamorro,Erik Cobo,Alex Rovira,L. San Román,Joaquín Serena,Sònia Abilleira,Marc Ribo,Mónica Millán,Xabier Urra,Pedro Cardona,E. López-Cancio,Alejandro Tomasello,Carlos Castaño,Jordi Blasco,Lucia Aja,Laura Dorado,Helena Quesada,Marta Rubiera,María Hernández-Pérez,Mayank Goyal,R. von Kummer,Antonio Dávalos +21 more
TL;DR: Among patients with anterior circulation stroke who could be treated within 8 hours after symptom onset, stent retriever thrombectomy reduced the severity of post-stroke disability and increased the rate of functional independence.
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