Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke: A New Standard of Care
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
The treatment of acute ischemic stroke (AIS) in the setting of intracranial large artery occlusion (LAO) with intravenous tissue plasminogen activator (IV-tPA) is associated with low rates of recanalization and high rates of neurological morbidity and functional dependence. Endovascular intervention, particularly mechanical thrombectomy, is a promising therapeutic adjunct to IV-tPA for the treatment of acute LAO. However, until recently, its efficacy has been controversial. In this brief review, we analyze the criticisms of three negative randomized controlled trials (RCT) of endovascular stroke treatment and evaluate the results from seven positive endovascular stroke RCTs that have recently been presented or published. IMS III, MR RESCUE, and SYTHESIS Expansion were three RCTs that failed to show a benefit from endovascular stroke therapy. Major criticisms of these studies included a lack of routine screening for LAO, resulting in the selection of AIS patients without LAO for endovascular intervention, and a low utilization rate of modern endovascular thrombectomy devices, leading to substandard rates of successful recanalization. MR CLEAN was the first phase III RCT to show a significant clinical benefit from endovascular stroke therapy. The dissemination of its findings elicited a cascade of positive results from, to date, six additional endovascular stroke RCTs, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THERAPY, and THRACE, which were halted prematurely for efficacy. The cumulative evidence from these studies shows an overwhelming benefit from the endovascular treatment of acute LAO, therefore effectively establishing a new standard of care for the management of AIS.
Abstract
The treatment of acute ischemic stroke (AIS) in the setting of intracranial large artery occlusion (LAO) with intravenous tissue plasminogen activator (IV-tPA) is associated with low rates of recanalization and high rates of neurological morbidity and functional dependence. Endovascular intervention, particularly mechanical thrombectomy, is a promising therapeutic adjunct to IV-tPA for the treatment of acute LAO. However, until recently, its efficacy has been controversial. In this brief review, we analyze the criticisms of three negative randomized controlled trials (RCT) of endovascular stroke treatment and evaluate the results from seven positive endovascular stroke RCTs that have recently been presented or published. IMS III, MR RESCUE, and SYTHESIS Expansion were three RCTs that failed to show a benefit from endovascular stroke therapy. Major criticisms of these studies included a lack of routine screening for LAO, resulting in the selection of AIS patients without LAO for endovascular intervention, and a low utilization rate of modern endovascular thrombectomy devices, leading to substandard rates of successful recanalization. MR CLEAN was the first phase III RCT to show a significant clinical benefit from endovascular stroke therapy. The dissemination of its findings elicited a cascade of positive results from, to date, six additional endovascular stroke RCTs, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THERAPY, and THRACE, which were halted prematurely for efficacy. The cumulative evidence from these studies shows an overwhelming benefit from the endovascular treatment of acute LAO, therefore effectively establishing a new standard of care for the management of AIS.
참고문헌 (13)
- Broderick JP, "Endovascular therapy after intravenous t-PA versus t-PA alone for stroke", N Engl J Med, 368, pp.893~903 (2013)
- Kidwell CS, "A trial of imaging selection and endovascular treatment for ischemic stroke", N Engl J Med, 368, pp.914~923 (2013)
- Ciccone A, "Endovascular treatment for acute ischemic stroke", N Engl J Med, 368, pp.904~913 (2013)
- Przybylowski CJ, "Evolution of endovascular mechanical thrombectomy for acute ischemic stroke", World J Clin Cases, 2, pp.614~622 (2014)
- Nogueira RG, "Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial", Lancet, 380, pp.1231~1240 (2012)
- Saver JL, "Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial", Lancet, 380, pp.1241~1249 (2012)
- Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
- Goyal M, "Randomized assessment of rapid endovascular treatment of ischemic stroke", N Engl J Med, 372, pp.1019~1030 (2015)
- Campbell BC, "Endovascular therapy for ischemic stroke with perfusion-imaging selection", N Engl J Med, 372, pp.1009~1018 (2015)
- Saver JL, "Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke", N Engl J Med (2015)[DOI]
- Jovin TG, "Thrombectomy within 8 hours after symptom onset in ischemic stroke", N Engl J Med (2015)[DOI]
- Mocco J, "The THERAPY trial: the randomized, concurrent controlled trial to assess the Penumbra System’s safety and effectiveness in the treatment of acute stroke", European Stroke Organization Conference (2015)
- Bracard S, "The contribution of intra-arterial thrombectomy in acute ischemic stroke in patients treated with intravenous thrombolysis", European Stroke Organization Conference (2015)