Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Abstract

Abstract-The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific

Vascular wall components in thrombi obtained by acute stroke thrombectomy: clinical significance and related factors

“…On the other hand, half of the VWC positive specimens (8% of total thrombi obtained) included the IEL in this study. Older age (mean age 74.9 years vs 67 years) and a higher proportion of East Asian patients, who are more likely to be affected by intracranial atherosclerosis than patients of other races,20 in the present study may be causal factors responsible for the difference in the detection rate of subendothelial connective tissue between the studies. Furthermore, arterial tortuosity and a small sized artery are thought to be caused by intracranial atherosclerosis, and a Japanese study showed that the horizontal segment of the middle cerebral artery tended to be angulated sharply in acute stroke patients who underwent MT 21.…”

Prediction of the Multisegment Clot Sign on Dynamic CT Angiography of Cardioembolic Stroke

“…17,18 The etiology of acute LAO seems related to stent retriever refractoriness and some other complications, such as inadvertent detachment, stent retrievers getting stuck, and frequent reocclusions. [19][20][21][22] The presence of truncal-site occlusion reflecting intracranial atherosclerosis was associated with a lower chance of stent retriever success, and these patients more frequently required adjunctive therapies, such as stent placement or use of glycoprotein IIb/IIIa inhibitors. 4 Failure of stroke intervention was associated with longer procedural times and delayed recanalization, resulting in larger infarct volumes and worse neurologic outcomes.…”

Isolated Posterior Inferior Cerebellar Artery Dissection as a Cause of Ischemic Stroke: Clinical Features and Prognosis

“…Contrary to the global predominance of extracranial artery dissection, cervicocephalic ADs were mostly identified in intracranial arteries (92%) in the Japanese multicenter observational SCADS-1 study [29] . Japanese patients, or those from East Asia, are known to show high susceptibility to intracranial vasculopathy, including intracranial atherosclerosis, lacunar stroke, intracerebral hemorrhage, moyamoya disease and hereditary disorders, such as cerebral autosomal dominant and cerebral autosomal recessive arteriopathies, with subcortical infarcts and leukoencephalopathy [32] . Such ethnic features may also be associated with a relatively high prevalence of PICA dissection when compared with previous studies.…”