Endovascular Intervention in Acute Ischemic Stroke: History and Evolution

Ansari, Junaid; Triay, Rachel; Kandregula, Sandeep; Adeeb, Nimer; Cuéllar, Hugo; Sharma, Pankaj

doi:10.3390/biomedicines10020418

Cited by 11 publications

(16 citation statements)

References 35 publications

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“…While early trials established the benefit of EVT when used within 6 hours from the onset of symptoms, more recent studies have included patients presenting outside this treatment window 18,19 . The DAWN and DEFUSE 3 trials demonstrated the benefit of reperfusion in selected patients presenting late with salvageable brain tissue 10 . The patients in these studies demonstrated small infarcted core volumes but large ischemic penumbra volumes on imaging; therefore, US and Canadian best practice guidelines recommend that patients being considered for EVT between 6 and 24 hours should meet the CT perfusion DWI criteria used in these trials 20,21 …”

Section: Treatment Time Windows For Evtmentioning

confidence: 99%

“…12 These early studies demonstrated better clinical outcomes and recanalization rates but a higher rate of symptomatic intracranial hemorrhage (ICH). 10 So began enthusiasm for the development of mechanical devices for clot retrieval.…”

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

“…Until the approval of tissue plasminogen activator for intravenous (IV) thrombolysis by the Food and Drug Administration (FDA) in 1996, there were few therapeutic options for managing stroke due to LVO. 10 While IV thrombolysis was shown to improve functional outcome at 90 days and had the advantage of low cost and ease of use, its narrow therapeutic window of 3 to 4.5 hours postsymptom onset meant it had limited efficacy. Further, the ability of IV thrombolysis to successfully achieve recanalization of LVOs is relatively poor when compared to smaller, more distal obstructions.…”

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

“…The MERCI trial reported a recanalization rate of 48%, significantly better than the 18% spontaneous recanalization rate previously reported in control groups and fewer hemorrhagic complications. 10 Despite there being no randomized trial favorably comparing these devices to medical management, by 2010, over 10,000 patients had been treated worldwide with the family of MERCI devices. 12 Meanwhile, second-generation thrombectomy devices were being developed, beginning with experimentation with the offlabel use of coronary stents.…”

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

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Acute ischemic stroke: practical considerations for anesthesiologists

Davis

2023

International Anesthesiology Clinics

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Section: Treatment Time Windows For Evtmentioning

confidence: 99%

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

Section: Evolution Of Management Of Lvo Aismentioning

confidence: 99%

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Acute ischemic stroke: practical considerations for anesthesiologists

Davis

2023

International Anesthesiology Clinics

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“…Thus, during the first three hours following the onset of this condition, the application of fibrinolytics achieves a marked reduction in disability in 25% of patients. Mechanical thrombectomy, which is normally only available in specialised centres and presents a heterogeneous international distribution, also increases survival rates and drastically decreases sequelae [ 7 , 8 , 9 , 10 ]. However, a high proportion of strokes are not suitable for any type of reperfusion, and it is these on which our study is focused.…”

Section: Introductionmentioning

confidence: 99%

Predictive Model and Mortality Risk Score during Admission for Ischaemic Stroke with Conservative Treatment

Lea-Pereira

Amaya-Pascasio

Martínez-Sánchez

et al. 2022

IJERPH

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Background: Stroke is the second cause of mortality worldwide and the first in women. The aim of this study is to develop a predictive model to estimate the risk of mortality in the admission of patients who have not received reperfusion treatment. Methods: A retrospective cohort study was conducted of a clinical–administrative database, reflecting all cases of non-reperfused ischaemic stroke admitted to Spanish hospitals during the period 2008–2012. A predictive model based on logistic regression was developed on a training cohort and later validated by the “hold-out” method. Complementary machine learning techniques were also explored. Results: The resulting model had the following nine variables, all readily obtainable during initial care. Age (OR 1.069), female sex (OR 1.202), readmission (OR 2.008), hypertension (OR 0.726), diabetes (OR 1.105), atrial fibrillation (OR 1.537), dyslipidaemia (0.638), heart failure (OR 1.518) and neurological symptoms suggestive of posterior fossa involvement (OR 2.639). The predictability was moderate (AUC 0.742, 95% CI: 0.737–0.747), with good visual calibration; Pearson’s chi-square test revealed non-significant calibration. An easily consulted risk score was prepared. Conclusions: It is possible to create a predictive model of mortality for patients with ischaemic stroke from which important advances can be made towards optimising the quality and efficiency of care. The model results are available within a few minutes of admission and would provide a valuable complementary resource for the neurologist.

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Efficacy and Safety of Sovateltide in Patients with Acute Cerebral Ischaemic Stroke: A Randomised, Double-Blind, Placebo-Controlled, Multicentre, Phase III Clinical Trial

Gulati,

Adwani,

Vijaya

et al. 2024

Drugs

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Background and Objectives Sovateltide (Tycamzzi™), an endothelin-B (ET-B) receptor agonist, increases cerebral blood flow, has anti-apoptotic activity, and promotes neural repair following cerebral ischaemic stroke. The objectives of this study were to evaluate the efficacy and safety of sovateltide in adult participants with acute cerebral ischaemic stroke. Methods This was a randomised, double-blind, placebo-controlled, multicentre, Phase III clinical trial of sovateltide in participants with cerebral ischaemic stroke receiving standard of care (SOC) in India. Patients aged 18-78 years presenting up to 24 h after the onset of symptoms with radiologic confirmation of ischaemic stroke and a National Institutes of Health Stroke Scale score (NIHSS) of ≥ 6 were enrolled. Patients with recurrent stroke, receiving endovascular therapy, or with intracranial haemorrhage were excluded. The study drug (saline or sovateltide [0.3 µg/kg] was administered intravenously in three doses at 3 ± 1 h intervals on Days 1, 3, and 6, and follow-up was 90 days). The Multivariate Imputation by Chained Equations (MICE) was used to impute the missing assessments on the endpoints. An unpaired t-test, two-way analysis of variance with Tukey's multiple comparison test, and the Chi-square test were used for the statistical analysis. The objective was to determine at Day 90 (1) the number of patients with a modified Rankin Scale score (mRS) 0-2, and (2) the number of patients with an NIHSS 0-5 at 90 days. Results Patients were randomised with 80 patients in the sovateltide and 78 in the control group. Patients received the investigational drug at about 18 h of stroke onset in both control and sovateltide groups. The median NIHSS at randomisation was 10.00 (95% CI 9.99-11.65) in the control group and 9.00 (95% CI 9.11-10.46) in the sovateltide group. Seventy patients completed the 90-day follow-up in the control group and 67 in the sovateltide group. The proportion of intentionto-treat (ITT) patients with mRS 0-2 score at Day 90 post-randomisation was 22.67% higher (odds ratio [OR] 2.75, 95% CI 1.37-5.57); similarly, the proportion of patients with NIHSS score of 0-5 at Day 90 was 17.05% more (OR 2.67, 95% CI 1.27-5.90) in the sovateltide group than in the control group. An improvement of ≥ 2 points on the mRS was observed in 51.28% and 72.50% of patients in the control and sovateltide groups, respectively (OR 2.50,. Seven of 78 patients (8.97%) in the control group and 7 of 80 (8.75%) in the sovateltide group developed intracranial haemorrhage (ICH). The adverse events were not related to sovateltide. Conclusions The sovateltide group had a greater number of cerebral ischaemic stroke patients with lower mRS and NIHSS scores at 90 days post-treatment than the control group. This trial supported the regulatory approval of sovateltide in India, but a multinational RESPECT-ET B trial will be conducted for US approval. Trial Registration Clinical Trials Registry, India (CTRI/2019/09/021373) and the United States National Library of Medicine, Clini...

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Endovascular Intervention in Acute Ischemic Stroke: History and Evolution

Cited by 11 publications

References 35 publications

Acute ischemic stroke: practical considerations for anesthesiologists

Acute ischemic stroke: practical considerations for anesthesiologists

Predictive Model and Mortality Risk Score during Admission for Ischaemic Stroke with Conservative Treatment

Efficacy and Safety of Sovateltide in Patients with Acute Cerebral Ischaemic Stroke: A Randomised, Double-Blind, Placebo-Controlled, Multicentre, Phase III Clinical Trial

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