Endovascular vs medical management of acute ischemic stroke

Chen, Ching-Jen; Ding, Dale; Starke, Robert M.; Mehndiratta, Prachi; Crowley, R. Webster; Liu, Kenneth C.; Southerland, Andrew M; Worrall, Bradford B.

doi:10.1212/wnl.0000000000002176

Cited by 147 publications

(110 citation statements)

References 31 publications

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“…It was noted that the distribution of Cog-4 scores was better in patients who received intravenous recombinant tissue plasminogen activator compared to those who were not thrombolysed, although this scale did not provide additional information beyond the modified Rankin Scale (mRS) assessment. 6 Endovascular treatment has recently demonstrated benefit in physical disability and functional outcome after acute stroke, 7 but the effect on cognitive outcomes has not been established yet. REVASCAT (Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours) randomized acute stroke patients either to medical therapy plus endovascular treatment thrombectomy or to medical treatment alone.…”

Section: Classification Of Evidencementioning

confidence: 99%

Endovascular treatment improves cognition after stroke

et al. 2017

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TMT was assessed in 82 of 84 patients undergoing thrombectomy and 86 of 87 control patients alive at 3 months and in 71 of 79 patients undergoing thrombectomy and 72 of 78 control patients alive at 1 year. Rates of timely TMT-A completion were similar in both treatment arms, although patients undergoing thrombectomy required less time for TMT-A completion and had higher rates of error-free TMT-A performance. Thrombectomy was also associated with a higher probability of timely TMT-B completion (adjusted odds ratio 3.17, 95% confidence interval 1.51-6.66 at 3 months; and adjusted ratio 3.66, 95% confidence interval 1.60-8.35 at 1 year) and shorter time for TMT-B completion. Differences in TMT completion times between treatment arms were significant in patients with good functional outcome but not in those who were functionally dependent (modified Rankin Scale score .2). Poorer cognitive outcomes were significantly associated with larger infarct volume, higher modified Rankin Scale scores, and worse quality of life.Conclusions: Thrombectomy improves TMT performance after stroke, especially among patients who reach good functional recovery.ClinicalTrials.gov identifier: NCT01692379.

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Section: Classification Of Evidencementioning

confidence: 99%

Endovascular treatment improves cognition after stroke

et al. 2017

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“…As this procedure requires trainees to manipulate the microcatheter and microwire and eventually deploy stents in intracranial vessels in addition to the placement of a guiding catheter, perfusion, and imaging, they can learn basic techniques of endovascular treatment. In addition, mechanical thrombectomy has been reported to be effective as a treatment for acute-phase cerebral infarction, [13][14][15][16] and shortening of the time until recanalization is a condition for improving the outcome. Therefore, simulation training in thrombectomy is considered to contribute to improvements in the clinical effectiveness and safety of catheter treatment.…”

Section: Resultsmentioning

confidence: 99%

Development of Simulator System Using Endovascular Evaluator for Catheter Intervention Training

Koyama

Hanaoka

Kiuchi

et al. 2018

JNET

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Objective: We formulated a simulator system for catheter intervention training by developing a sliding table and an electrically controlled camera-holding C-arm and combining them with the silicone vessel model EndoVascular Evaluator (EVE). We performed simulation of mechanical thrombectomy using this system and evaluated its usability for simulation training.Methods: After three experts in neuroendovascular treatment were given instructions for the use of this system, they performed mechanical thrombectomy by a procedure as close as possible to that in clinical situations using an artificial thrombus model simulating left middle cerebral artery occlusion, and the procedural times and maneuvers were studied.The time required for guiding catheter placement in the cervical internal carotid artery (guiding time), time required for stent placement (stent placement time), and time required for retrieval of thrombus together with the stent (stent retrieval time) were measured, and the number of movements of the sliding table and C-arm during the procedure were counted. Results:The intended procedure could be executed faithfully by all physicians. The mean guiding, stent placement, and stent retrieval times were 185 ± 18, 387 ± 33, and 616 ± 27 seconds, respectively. The mean numbers of table and C-arm movements during the procedure were 14 ± 1.7 and 8.3 ± 0.5, respectively. Conclusion:This system allows operators to faithfully reproduce the mechanical thrombectomy procedure and is considered to have functions necessary for simulation training of catheter intervention and performance assessment.

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“…In 2015, five studies reported strong evidence that intraarterial interventions (intraarterial thrombolysis, mechanical clot retrieval, or both) combined with standard medical management improves the outcomes of appropriately selected patients with AIS and large artery occlusion [17]. A subsequent metaanalysis that included pre-2015 studies confirmed that endovascular thrombectomy is associated with higher rates of angiographic revascularization and improved functional outcomes, but it found no significant difference in symptomatic intracranial hemorrhage or all-cause mortality at 90 days after large artery occlusion-related AIS [18].…”

Section: Strokementioning

confidence: 99%