Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial

Bracard, Serge; Ducrocq, Xavier; Mas, Jean Louis; Soudant, Marc; Oppenheim, Catherine; Moulin, Thierry; Guillemin, Françis

doi:10.1016/s1474-4422(16)30177-6

Cited by 1,052 publications

(764 citation statements)

References 24 publications

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“…Recently it was shown that intra‐arterial treatment (IAT) is highly effective in patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, and it has revolutionized stroke treatment 1, 2, 3, 4, 5, 6…”

mentioning

confidence: 99%

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Autar

Hund

Ramlal

et al. 2018

JAHA

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BackgroundCurrently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR‐CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent‐retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices.Methods and ResultsSeven stent‐retrievers with thrombi still entrapped were collected directly after thrombectomy. The stent‐retrievers were studied using micro computed tomography, followed by scanning electron microscopy and light microscopy. Two independent observers rated interaction type and thrombus surface structure (porous filamentous or dense) at the interaction sites.A total of 79 interaction sites between thrombus and stent‐retriever were categorized. Thrombus‐stent‐retriever interaction was found to be adhesive (n=44; 56%) or mechanical (n=35; 44%). Adhesive interaction was most frequently observed at interaction sites with a dense surface, compared with interaction sites with a porous filamentous fibrin surface (38/58; 66% versus 6/21; 29%, P=0.011).ConclusionsThe interaction between thrombus and stent‐retriever was predominantly adhesive, not mechanical. Adhesive interaction was strongly associated with the presence of a dense thrombus surface without a porous filamentous fibrin network.

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mentioning

confidence: 99%

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Autar

Hund

Ramlal

et al. 2018

JAHA

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“…[25][26][27] Mörg önnur lönd eru að íhuga slíkar breytingar hvað varðar meðferð bráðra blóðþurrðarslaga. Auk þessara rannsókna hafa baest við tvaer aðrar rannsóknir, 28 (önnur þeirra: Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke, hefur ekki enn verið birt) en líkt og rannsóknir sem komu í kjölfar fyrstu rannsóknarinnar (MRCLEAN), 17 varð að haetta þeim öllum fyrr en áaetlað var vegna afgerandi árangurs rannsóknarmeðferðarinnar miðað við samanburðarhóp.…”

Section: Inngangurunclassified

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

Sigurdsson

2018

LBL

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“…presenting with large vessel occlusion in the anterior circulation [16][17][18][19][20]. A sixth positive trial has been published in 2016 [21]. These six trials focused on the previous deficiencies in order to maximize work-flow and patient selection, by 1) mandating universal vascular imaging to identify patients with proximal occlusion 2) emphasizing rapid door-torecanalization times, and 3) use of advanced retrievable stent technology.…”

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confidence: 99%

An historical and contemporary review of endovascular therapy for acute ischemic stroke

2017

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Long standing, evidence based approved therapies for acute ischemic stroke include intravenous thrombolysis therapy (IVT) with alteplase (recombinant tissue plasminogen activator, rtPA) given within 4.5 h; aspirin therapy within 48 h; management in an acute stroke unit and hemicraniectomy in cases of malignant infarction. Multiple recent positive randomized controlled trials (RCTs) have now also established endovascular therapy with mechanical thrombectomy as the standard of care for acute ischemic stroke involving a large vessel occlusion in the anterior circulation. This article will review the history of endovascular treatments for acute ischemic stroke and will review the recent positive and negative randomized controlled trial evidence for its efficacy. Current guidelines and dilemmas regarding appropriate patient selection will be discussed.

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Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial

Cited by 1,052 publications

References 24 publications

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

An historical and contemporary review of endovascular therapy for acute ischemic stroke

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