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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular therapy for acute ischemic stroke: The standard of care
Ashutosh P Jadhav1, Tudor G Jovin1
1University of Pittsburgh Medical Center, UPMC Stroke Institute, Pittsburgh, PA, USA.
Insights
Intra-arterial therapy has become a new standard of care for acute ischemic stroke, especially for large vessel occlusive disease. Recent trials show improved patient outcomes due to faster and higher rates of recanalization.
Area of Science:
- Neurology
- Vascular Medicine
- Emergency Medicine
Background:
- Acute ischemic stroke is a leading cause of death and disability globally.
- Large vessel occlusive disease leads to poor outcomes in stroke patients.
- Current treatments like intravenous thrombolysis have limitations.
Purpose of the Study:
- To evaluate the efficacy of intra-arterial therapy in acute ischemic stroke.
- To compare intra-arterial therapy with medical therapy alone.
- To establish a new standard of care for stroke management.
Main Methods:
- Review of recent clinical trials (2015) investigating intra-arterial therapy.
- Analysis of patient outcomes in large vessel occlusive disease.
- Comparison of recanalization rates between different treatment modalities.
Main Results:
- Five major trials in 2015 demonstrated superior outcomes with intra-arterial therapy.
- Intra-arterial therapy achieved higher and faster recanalization rates.
- A select patient population showed significant benefit from this intervention.
Conclusions:
- Intra-arterial therapy represents a significant advancement in acute ischemic stroke management.
- This approach has become a new standard of care for eligible stroke patients.
- Improved recanalization is key to better outcomes in large vessel occlusive disease.
Abstract:
Acute ischemic stroke continues to be a major cause of permanent disability and death worldwide. Outcomes are particularly poor in patients presenting with large vessel occlusive disease with resultant ischemia and tissue injury in large and eloquent territories. Intravenous thrombolysis has been the mainstay of medical therapy, however treatment is limited to a subset of patients and many patients continue to have poor outcomes. Three trials in 2013 investigating the benefit of intra-arterial therapy failed to demonstrate benefit over medical therapy alone. More recently, five trials in 2015 were completed demonstrating superior outcomes with intra-arterial therapy with improved results attributed to higher and faster rates of recanalization in a select patient population. These trials have introduced a new standard of care in the management of acute ischemic stroke patients.
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