Mechanical Thrombolysis in Acute Ischemic Stroke With Endovascular Photoacoustic Recanalization

Berlis, Ansgar; Lutsep, Helmi L.; Barnwell, S L; Norbash, Alexander; Wechsler, Lawrence R.; Jungreis, Charles A.; Woolfenden, Andrew R.; Redekop, Gary; Hartmann, Marius; Schumacher, Martin

doi:10.1161/01.str.0000124126.17508.d3

Cited by 130 publications

(74 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A Swiss study reported higher recanalization rates with mechanical clot fragmentation in patients who had received intra-arterial thrombolytic therapy 58 .…”

Section: Mechanical Clot Fragmentationmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Martins¹,

Freitas²,

Pontes-Neto³

et al. 2012

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…A Swiss study reported higher recanalization rates with mechanical clot fragmentation in patients who had received intra-arterial thrombolytic therapy 58 .…”

Section: Mechanical Clot Fragmentationmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Martins¹,

Freitas²,

Pontes-Neto³

et al. 2012

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…The overall mortality rate was 38.2%. 71 The LaTIS laser device (LaTIS, Minneapolis, Minn) uses the slow injection of contrast material as a "light pipe" to carry the energy from the catheter to the embolus. 50 The device was evaluated in a safety and feasibility trial at 2 US centers.…”

mentioning

confidence: 99%

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Nogueira¹,

Schwamm²,

Hirsch³

2009

AJNR Am J Neuroradiol

121

111

View full text Add to dashboard Cite

SUMMARY:Despite years of research and pioneering clinical work, stroke remains a massive public health concern. Since 1996, we have lived in the era of US Food and Drug AdministrationϪapproved intravenous (IV) recombinant tissue plasminogen activator (rtPA). This treatment, despite its promise, continues to exhibit its limitations. Endovascular therapy has several theoretic advantages over IV rtPA, including site specificity, longer treatment windows, and higher recanalization rates. In this article, we will review the various pharmacologic strategies for acute stroke treatment, providing both a historic context and the state of the art. The drugs will be classified on the basis of their theoretic rationale for therapy. Next, we will review the various devices and strategies for mechanical revascularization with an aim toward comprehensiveness. These range from wire disruption of thrombus to preclinical trials for novel mechanical solutions. This first installment of this 2-part series will end with an analysis of retrograde reperfusion techniques.

show abstract

“…31 Others have attempted to dispose laser energy at the site of intracranial occlusion, but that has been taken out of US markets. 32 Along with the size-related limiting of these applications for AIS, the impartation of heat energy may be deleterious.…”

Section: Thrombectomy and Mechanical Thrombus Dissolutionmentioning

confidence: 99%

Past, present, and future of endovascular stroke therapies

et al. 2012

View full text Add to dashboard Cite

Endovascular therapy in the acute management of ischemic stroke has become more common with technologic advances, such as easier navigation into the intracranial circulation and improved treatment efficacy with the advent of revascularization devices. This select review outlines milestones in the application of endovascular therapy in acute ischemic stroke (AIS) and offers some insight into important factors influencing the future directions of endovascular AIS treatment. In particular, we discuss the evolution of endovascular devices for AIS and how ingenuity continues to offer novel treatments. With these advances, the future of endovascular AIS treatment is promising. Neurology ® 2012;79 (Suppl 1):S213-S220 GLOSSARY AIS ϭ acute ischemic stroke; DAC ϭ distal access catheter; FDA ϭ US Food and Drug Administration; HDE ϭ humanitarian device exemption; IA ϭ intra-arterial; IMS ϭ Interventional Management of Stroke; IU ϭ international units; MERCI ϭ Mechanical Embolus Removal in Cerebral Ischemia; PMA ϭ premarket approval; SICH ϭ symptomatic intracerebral hemorrhage; TIMI ϭ thrombolysis in myocardial ischemia; tPA ϭ tissue plasminogen activator.The concept of interventional treatment of acute ischemic stroke (AIS) is analogous to the percutaneous treatment of acute myocardial infarction in that the occlusive lesion is accessed via the vascular system and recanalization is achieved with endovascular techniques. Such an approach has become a standard treatment for acute coronary syndromes but has not achieved widespread acceptance for AIS. This is in large part due to the limitations of a single US Food and Drug Administration (FDA)-approved treatment for AIS, narrow therapeutic windows for treatment, and an immature repertoire of endovascular tools available for the neurointerventionalist. However, over the last 16 years, since FDA approval of tissue plasminogen activator (tPA), the field of stroke neurology has bridged this gap with improved imaging techniques and clinical trial design to consider endovascular treatment. This has been coupled with better navigation into the intracranial circulation with a newer generation of cerebral-specific catheters, microwires, and, ultimately, reperfusion devices.This review evaluates and discusses the different endovascular strategies for acute ischemic stroke treatment, including the evolution of each technique over the past decade. These strategies include the following:1. Chemical local recanalization 2. Mechanical recanalization 3. Augmentation of collateral flow or reversal of flow CHEMICAL LOCAL RECANALIZATION Early endovascular treatment of AIS was limited by the difficulty in achieving distal cranial access. Access into the proximal vessels (carotid and vertebral arteries) was possible, however, and medications were delivered here for thrombolysis of cerebral emboli.1,2 These preliminary reports suggested the possibility of a 75% rate of recanalization, though this was associated with 20% incidence of asymptomatic hemorrhagic conversion. In 1999, the Prolyse ...

show abstract

Mechanical Thrombolysis in Acute Ischemic Stroke With Endovascular Photoacoustic Recanalization

Abstract: This study demonstrates the safety and technical feasibility of EPAR. This new technique may provide another treatment option in the therapeutic armamentarium for patients with acute ischemic stroke.

Cited by 130 publications

References 17 publications

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

Past, present, and future of endovascular stroke therapies

Contact Info

Product

Resources

About