Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

Jakubowska, Małgorzata; Michels, Peter; Müller-Jensen, A.; Leppien, Andreas; Eckert, Bernd

doi:10.1007/s00234-008-0385-7

Cited by 11 publications

(3 citation statements)

References 12 publications

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“…Several reports have suggested that fluctuating symptoms might be a manifestation of intracranial vascular occlusion with marginal blood flow supplied by collateral circulation. 36 In particular, fluctuating symptoms may suggest existing but unstable and insufficient collateralization, 37 which means that intervention including thrombolytic therapy should be considered for patients with this pattern of symptoms. We thought that fluctuating symptoms could be one of the surrogate markers to predict in situ stenosis as the cause of the occlusion.…”

Section: Discussionmentioning

confidence: 99%

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

Bae¹,

Jung²,

Kim³

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Absence of the MCA susceptibility vessel sign (negative MCA susceptibility vessel sign) on gradient recalled-echo MR imaging in acute stroke is commonly associated with in situ stenosis and thrombotic occlusion. We evaluated the effectiveness and safety of the Solitaire stent as the first-line device for the recanalization of MCA occlusion with a negative MCA susceptibility vessel sign.

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Section: Discussionmentioning

confidence: 99%

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

Bae¹,

Jung²,

Kim³

et al. 2013

AJNR Am J Neuroradiol

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“…Therefore more extensive clinical trials are still required to prove their clinical benefits. The required dose of tPA for intra-arterial thrombolysis (IAT) is smaller than that for intravenous thrombolysis and has been shown to lead to a higher recanalization rate beyond the three -hour window without an increased rate of complications in carefully selected patients 7,[11][12][13] . Previous studies have also shown a lower recanalization rate in patients with large vessel occlusion who were treated by intravenous thrombolysis 9,[11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

In-Room Assessment of Cerebral Blood Volume for Guidance during Intra-Arterial Thrombolytic Therapy

Lin

Hung

et al. 2012

Interv Neuroradiol

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In acute ischemic stroke, the ability to estimate the penumbra and infarction core ratio helps to triage those who will potentially benefit from thrombolytic therapies. Flat-panel post-contrast DynaCT imaging can provide both vasculature and parenchymal blood volume within the angio room to monitor hemodynamic changes during the endovascular procedures. We report on an 80-year-old woman who suffered from an acute occlusion of the right distal cervical internal carotid artery. She was transferred to the angio room where in-room post-contrast flat-panel DynaCT imaging (syngo Neuro PBV IR) was performed to access the ischemic tissue, followed by successful mechanical thrombolytic therapy.

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“…Interventional stroke therapies with treatment onset in the 6-to 9-h time windows have been described and should be based on individual brain vessel pathology with favorable penumbral tissue evaluation [38].…”

Section: Anterior Circulationmentioning

confidence: 99%

Acute Stroke Therapy 1981–2009*

Eckert

2009

Clin Neuroradiol

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This article includes a review of major intravenous and endovascular stroke trials, treatment options, and future aspects of acute stroke treatment in hemispheric and vertebrobasilar stroke. Since the invention of local intraarterial thrombolysis by Hermann Zeumer in 1981, acute stroke diagnostics and treatment have undergone dramatic improvement. This article addresses major topics in recent stroke treatment debates: optimization of patient selection, intravenous versus endovascular therapy, time window limitations, combined treatment with intravenous/intraarterial bridging therapies (intravenous/intraarterial recombinant tissue plasminogen activator [rtPA] bridging and intravenous glycoprotein IIb/IIIa inhibitor/intraarterial rtPA bridging) and modern endovascular treatment modes like percutaneous transluminal angioplasty (PTA)/stenting and mechanical thrombectomy devices. Modern acute stroke therapy networks should optimize their noninvasive diagnostic capacity to early identify candidates for endovascular therapy with rapid access to specialized neuroendovascular centers using standard protocols. The most promising approach in acute stroke treatment seems to be a combination of intravenous and endovascular revascularization procedure, combining early treatment initiation with direct clot manipulation and PTA/stenting in underlying stenosis with atherothrombotic occlusions. Further randomized studies comparing intravenous and endovascular treatment, mainly in the anterior circulation, have to be expected and need wide support of the neurologic and neuroradiologic stroke community.

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Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

Cited by 11 publications

References 12 publications

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

In-Room Assessment of Cerebral Blood Volume for Guidance during Intra-Arterial Thrombolytic Therapy

Acute Stroke Therapy 1981–2009*

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