Endovascular treatment of cerebrovascular accident
Authors:
J. Kozák 1,2; R. Kozáková 2; D. Kučera 1,3
Authors‘ workplace:
Vaskulární centrum, Vítkovická nemocnice a. s., Ostrava
1; Fakulta zdravotních věd, UP v Olomouci
2; II. interní klinika kardiologie a angiologie 1. LF UK a VFN v Praze
3
Published in:
Kardiol Rev Int Med 2016, 18(3): 151-156
Overview
Cerebrovascular accident (CVA) is one of the leading causes of patient morbidity, mortality and disability, especially in developed countries. Ischaemic CVA (iCVA) constitutes 80–85% of all CVA, the most common cause being an acute occlusion of cerebral artery, proved in more than 70% of patients within the first few hours after the onset of symptoms. An early cerebral artery recanalisation leads to reduced mortality and increased chance of patients’ self-sufficiency within 3 months after the stroke. Apart from pharmacological approaches to iCVA treatment (i.e. systemic, local, or combined administration of thrombolytics), endovascular techniques and methods are currently used. These methods have been undergoing a dynamic development during the last decade, and extensive clinical randomised trials prove their clear positive impact on the early reperfusion of the occluded cerebral artery, and, consequently, on a better prognosis for iCVA patients. The article describes individual endovascular instruments and the results of studies that demonstrated safety and efficacy of individual mechanical instruments proved by the ever-increasing proportion of successful recanalisations and relatively low risk of both periprocedural and postprocedural complications. Nowadays (since 2015) systemic thrombolysis combined with mechanical thrombectomy represents the method of choice for the treatment of major cerebral arterial occlusions within 4.5 hours after the onset of clinical symptoms, while mechanical thrombectomy alone with stent-retrievers is the standard treatment of acute symptomatic cerebral artery occlusion within 6 hours after the iCVA event.
Keywords:
ischaemic stroke – mechanical thrombectomy – stent-retrievers
Sources
1. Truelsen T, Piechowski-Jóźwiak B, Bonita R et al. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol 2006; 13: 581–598.
2. Fieschi C, Argentino C, Lenzi GL et al. Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 1989; 91: 311–321.
3. Mattle HP, Arnold M, Lindsberg PJ et al. Basilar artery occlusion. Lancet Neurol 2011; 10: 1002–1014. doi: 10.1016/S1474-4422 (11) 70229-0.
4. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38: 967–973.
5. von Kummer R, Holle R, Gizyska U et al. Interobserver agreement in assessing early CT signs of middle cerebral artery infarction. AJNR Am J Neuroradiol 1996; 17: 1743–1748.
6. Barber PA, Demchuk AM, Zhang J et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 2000; 355: 1670–1674.
7. Jauch EC, Saver JL, Adams HP et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke 2013; 44: 870–947.
8. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Should the time window for intravenous thrombolysis be extended? Available from: http: //www.eso-stroke.org/pdf/ESO_Guideline_Update_Jan_2009.pdf.
9. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–1588. doi: 10.1056/NEJM19 9512143332401
10. Hacke W, Kaste M, Bluhmki E et al. ECASS 3 Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–1329. doi: 10.1056/NEJMoa0804 656.
11. Külkens S, Hacke W. Thrombolysis with alteplase for acute ischemic stroke: review of SITS-MOST and other Phase IV studies. Expert Rev Neurother 2007; 7: 783–788.
12. Lee KY, Han SW, Kim SH et al. Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients. Stroke 2007; 38: 192–193.
13. Krajina A, Krajíčková D, Špriňar Z et al. Mechanická perkutánní extrakce embolu při akutní cévní mozkove přihodě: kasuistika a přehled literatury. Cesk Slov Neurol 2005; 65/101: 51–57.
14. Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial part I. AJNR Am J Neuroradiol 2006; 27: 1177–1182.
15. Smith WS, Sung G, Saver J et al. Multi MERCI Investigators. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI Trial. Stroke 2008; 39: 1205–1212. doi: 10.1161/STROKEAHA.107.497115.
16. Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009; 40: 2761–2768. doi: 10.1161/STROKEAHA.108.544957.
17. Widimský P, Kožnar B, Vaško P et al. Acute myocardial infarction and acute stroke: what are the differences? Focus on reperfusion therapy. Cor Vasa 2013; 55: e111–e116.
18. Mahon BR, Nesbit GM, Barnwell SL et al. North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 2003; 24: 534–538.
19. Krajina A, Krajíčková D, Lojík M et al. Endovaskularni rekanalizace při lečba akutnich uzavěrů mozkovych tepen. Cesk Slov Neurol N 2010; 73/106: 678–684.
20. Machi P, Costalat V, Lobotesis K et al. Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 2012; 4: 62–66. doi: 10.1136/jnis. 2010.004051.
21. Roth C, Papanagiotou P, Behnke S et al. Stent- -assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 2010; 41: 2559–2567. doi: 10.1161/STROKEAHA.110.592071.
22. Seifert M, Ahlbrecht A, Dohmen C et al. Combined interventional stroke therapy using intracranial stent and local intra-arterial thrombolysis (LIT). Neuroradiology 2011; 53: 273–282. doi: 10.1007/s00234-010-0719-0.
23. Nogueira RG, Lutsep HL, Gupta R et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012; 380: 1231–1240. doi: 10.1016/S0140-6736 (12) 61299-9.
24. Saver JL, Jahan R, Levy EI et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012; 380: 1241–1249. doi: 10.1016/S0140-6736 (12) 61 384-1.
25. Mourand I, Brunel H, Costalat V et al. Mechanical thrombectomy in acute ischemic stroke: catch device. AJNR Am J Neuroradiol 2011; 32: 1381–1385. doi: 10.3174/ajnr.A2563.
26. Leading Product Innovatorin Interventional Neuroradiology. Available from: www.phenox.net.
27. Broderick JP, Palesch YY, Demchuk AM et al. Endovascular therapy after intravenous rt-PA versus t-PA alone for stroke. N Engl J Med 2013; 368: 893–903. doi: 10.1056/NEJMoa1214300.
28. Kidwell SC, Jahan R, Gornbein J et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368: 914–923. doi: 10.1056/NEJMoa1212793.
29. Ciccone A, Valvassori L, Nichelatti M et al. Endovascular Treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904–913. doi: 10.1056/NEJMoa1213701.
30. Berkhemer OA, Fransen PS, Beumer D et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20. doi: 10.1056/NEJMoa1411587.
31. Campbell BC, Mitchell PJ, Kleinig TJ et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018. doi: 10.1056/NEJMoa1414792.
32. Goyal M, Demchuk AM, Menon BK et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030. doi: 10.1056/NEJMoa1414905.
33. Saver JL, Goyal M, Bonafe A et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295. doi: 10.1056/NEJMoa1415061.
34. Jovin TG, Chamorro A, Cobo E et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306. doi: 10.1056/NEJMoa1503780.
35. Bush CK, Kurimella D, Cross LJ et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One 2016; 11: e0147287. doi: 10.1371/journal.pone.0147287.
36. Kumar G, Shahripour RB, Alexandrov AV. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. J Neurointervent Surg 2015; 7: 868–874. doi: 10.1136/neurintsurg-2014-011418.
37. Lapergue B, Blanc R, Guedin P et al. A Direct Aspiration, First Pass Technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am Neuroradiol 2016. [Epub ahead of print].
Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
2016 Issue 3
Most read in this issue
- Beta-blockers with the smallest negative impact on cardiorespiratory fitness in healthy people
- Endovascular treatment of iliofemoral deep venous thrombosis
- Possibilities of endovascular treatment of acute limb ischaemia
- Type B aortic dissection with severe visceral and limb ischaemia treated with a complete endovascular revascularisation – a case report