Related Experiment Video

Updated: May 11, 2026

A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model
09:42

A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model

Published on: June 4, 2021

Trials of endovascular therapies or collaterals?

David S Liebeskind1

  • 1UCLA Stroke Center, Los Angeles, CA 90095, USA. davidliebeskind@yahoo.com

International Journal of Stroke : Official Journal of the International Stroke Society
|May 23, 2013
PubMed

Insights

Recent endovascular stroke trials highlight the critical role of collateral perfusion. Optimal patient selection based on imaging, rather than time, may be key to successful acute ischemic stroke treatment.

Area of Science:

  • Neurology
  • Interventional Neurology
  • Vascular Neurology

Background:

  • Landmark clinical trials in endovascular therapy for acute ischemic stroke have prompted reevaluation of revascularization strategies.
  • Recent trials (IMS III, MR RESCUE, SWIFT, TREVO2) suggest underlying pathophysiology, particularly collateral perfusion, significantly impacts outcomes.

Purpose of the Study:

  • To investigate whether recent endovascular stroke trial results reflect specific treatment efficacy or the importance of underlying pathophysiology.
  • To determine the paramount role of collateral perfusion in acute ischemic stroke outcomes.

Main Methods:

  • Analysis of data from four major endovascular stroke trials: IMS III, MR RESCUE, SWIFT, and TREVO2.
  • Examination of the impact of collateral perfusion on treatment outcomes in acute ischemic stroke.

Main Results:

  • Consistent demonstration of the dramatic impact of collateral perfusion in acute ischemic stroke across all analyzed trials.
  • Evidence suggests that patient selection based on underlying pathophysiology (collateral status) is crucial.

Conclusions:

  • The effectiveness of endovascular therapy for acute ischemic stroke may be more dependent on patient selection, specifically collateral status, than on the specific device or drug used.
  • Future trials should consider collateral status as a critical selection criterion, potentially shifting triage from time-based to imaging-based strategies.
  • Focusing on treating the optimal patient, identified through imaging, may be more effective than pursuing a "magical" therapy.

More Related Videos

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...