Acute Ischemic Stroke Intervention
Abstract Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2016-06, Vol.67 (22), p.2631-2644 |
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| creator | Khandelwal, Priyank, MD Yavagal, Dileep R., MD, MBBS Sacco, Ralph L., MD, MS |
| description | Abstract Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evolution of catheter-based treatment from first-generation thrombectomy devices to the game-changing stent retrievers, results from recent trials, and the evolving stroke systems of care to provide timely access to acute stroke intervention to patients in the United States. |
| doi_str_mv | 10.1016/j.jacc.2016.03.555 |
| format | Article |
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Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evolution of catheter-based treatment from first-generation thrombectomy devices to the game-changing stent retrievers, results from recent trials, and the evolving stroke systems of care to provide timely access to acute stroke intervention to patients in the United States.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2016.03.555</identifier><identifier>PMID: 27256835</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Brain - diagnostic imaging ; Cardiology ; Cardiovascular ; Endovascular Procedures ; FDA approval ; Fibrinolytic Agents - therapeutic use ; Heart attacks ; Humans ; Internal Medicine ; large vessel occlusion ; Magnetic Resonance Angiography ; mechanical thrombectomy ; Medical imaging ; Mortality ; Neuroimaging ; NMR ; Nuclear magnetic resonance ; Patient Selection ; Randomized Controlled Trials as Topic ; stent retrievers ; Stroke ; Stroke - mortality ; Stroke - therapy ; stroke systems ; Thrombectomy - instrumentation ; Time-to-Treatment ; Tissue Plasminogen Activator - therapeutic use ; Tomography, X-Ray Computed ; Veins & arteries</subject><ispartof>Journal of the American College of Cardiology, 2016-06, Vol.67 (22), p.2631-2644</ispartof><rights>American College of Cardiology Foundation</rights><rights>2016 American College of Cardiology Foundation</rights><rights>Copyright © 2016 American College of Cardiology Foundation. 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All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 7, 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-941b35e091611aee94bf04c3264fa8f2cc268ced89b098b5cd1a90d739ea1db93</citedby><cites>FETCH-LOGICAL-c483t-941b35e091611aee94bf04c3264fa8f2cc268ced89b098b5cd1a90d739ea1db93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109716325943$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27256835$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khandelwal, Priyank, MD</creatorcontrib><creatorcontrib>Yavagal, Dileep R., MD, MBBS</creatorcontrib><creatorcontrib>Sacco, Ralph L., MD, MS</creatorcontrib><title>Acute Ischemic Stroke Intervention</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Abstract Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. 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Yavagal, Dileep R., MD, MBBS ; Sacco, Ralph L., MD, MS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-941b35e091611aee94bf04c3264fa8f2cc268ced89b098b5cd1a90d739ea1db93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Brain - diagnostic imaging</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Endovascular Procedures</topic><topic>FDA approval</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>large vessel occlusion</topic><topic>Magnetic Resonance Angiography</topic><topic>mechanical thrombectomy</topic><topic>Medical imaging</topic><topic>Mortality</topic><topic>Neuroimaging</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Patient Selection</topic><topic>Randomized Controlled Trials as Topic</topic><topic>stent retrievers</topic><topic>Stroke</topic><topic>Stroke - mortality</topic><topic>Stroke - therapy</topic><topic>stroke systems</topic><topic>Thrombectomy - instrumentation</topic><topic>Time-to-Treatment</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Tomography, X-Ray Computed</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khandelwal, Priyank, MD</creatorcontrib><creatorcontrib>Yavagal, Dileep R., MD, MBBS</creatorcontrib><creatorcontrib>Sacco, Ralph L., MD, MS</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khandelwal, Priyank, MD</au><au>Yavagal, Dileep R., MD, MBBS</au><au>Sacco, Ralph L., MD, MS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute Ischemic Stroke Intervention</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2016-06-07</date><risdate>2016</risdate><volume>67</volume><issue>22</issue><spage>2631</spage><epage>2644</epage><pages>2631-2644</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Abstract Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. 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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Brain - diagnostic imaging Cardiology Cardiovascular Endovascular Procedures FDA approval Fibrinolytic Agents - therapeutic use Heart attacks Humans Internal Medicine large vessel occlusion Magnetic Resonance Angiography mechanical thrombectomy Medical imaging Mortality Neuroimaging NMR Nuclear magnetic resonance Patient Selection Randomized Controlled Trials as Topic stent retrievers Stroke Stroke - mortality Stroke - therapy stroke systems Thrombectomy - instrumentation Time-to-Treatment Tissue Plasminogen Activator - therapeutic use Tomography, X-Ray Computed Veins & arteries |
| title | Acute Ischemic Stroke Intervention |
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