Home Hemorrhagic and Ischemic Stroke The review highlights the evolving role of endovascular therapy in the treatment of ischemic stroke

The review highlights the evolving role of endovascular therapy in the treatment of ischemic stroke

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The review highlights the evolving role of endovascular therapy in the treatment of ischemic stroke

Stroke as a consequence of large vessel occlusion (LVO) is a number one explanation for disability and death worldwide. Endovascular therapy (minimally invasive procedures corresponding to catheterization inside blood vessels) has modified the management of those patients. In 2015, several randomized trials demonstrated the prevalence of endovascular therapy over medical management in reducing disability in some patients, most of whom had a small spinal infarction and presented to the emergency department inside six hours of symptom onset. Evidence in favor of treatment has also been prolonged to patients presenting inside 24 hours of symptom onset, patients with large spinal ischemic infarction, and patients with basilar artery occlusion.

Nonetheless, knowledge gaps remain, including: knowledge of which patients with large ischemic infarction usually tend to profit from endovascular therapy; the role of endovascular therapy in patients with low stroke severity on the National Institutes of Health Stroke Scale (NIHSS) or with medium or distal vessel occlusion (blood blockage); and optimal treatment of patients with underlying intracranial atherosclerotic disease.

In a review article published within the journal Lancet, researchers from Boston University Chobanian & Avedisian School of Medicine and international collaborators examined the rationale behind recent randomized trial designs and outcomes which have demonstrated the advantages of endovascular therapy, including reviewing current devices and addressing current areas inside the therapy . test.

Our work is a recent update of the role of endovascular therapy (clot removal, rescue stenting) within the treatment of patients with acute ischemic stroke and the standards for patient selection.”

Thanh Nguyen, MD, corresponding writer, professor of neurology, neurosurgery and radiology, Boston University School of Medicine

Using a Medline database search, researchers reviewed randomized clinical trials from 2015 to 2024 that compared endovascular therapy with medical therapy for giant vessel occlusion stroke. Medical management included thrombolytics (medicines that dissolve blood clots), blood pressure medications, and treatment for vascular risk aspects. They found that randomized trials using a brand new generation of devices clearly demonstrated the prevalence of endovascular therapy over best medical therapy in chosen patients.

In addition they found that patient selection for endovascular therapy may very well be summarized based on clinical and imaging criteria, using a minimalist approach based on evolving randomized evidence. “Most patients with an NIHSS rating greater than 5 and anterior circulation obstruction on imaging, in addition to patients with an anterior circulation obstruction rating of a minimum of 10 on the NIHSS and basilar occlusion without extensive infarction on imaging, are good candidates for endovascular treatment inside a 24-hour treatment window. ” explains Nguyen, who can be a neurologist and director of Interventional Neurology/Neurradiology at Boston Medical Center.

In accordance with Dr. Mohamad AbdalKader, professor of radiology at the varsity and co-author of the paper, there was a remarkable change within the care of patients with LVO over the past decade. “Advances from clinical trial data, endovascular therapy devices and techniques, broadening indications for endovascular therapy, and reducing imaging barriers to endovascular therapy selection have improved our understanding of find out how to optimize the care of those patients,” adds AbdalKader, who can be a neuroradiologist. diagnostic and interventional at Boston Medical Center.

These findings appear in an internet journal Lancet.

Source:

Magazine number:

Nguyen, Tennessee et al. (2024) Endovascular treatment of acute stroke. Lancet. doi.org/10.1016/S0140-6736(24)01410-7.

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