Abstract

Research Article

Endovascular treatment experience in acute ischemic stroke

İbrahim Acır*, Vildan Yayla and Hacı Ali Erdoğan

Published: 26 April, 2021 | Volume 5 - Issue 1 | Pages: 026-028

Background and Objective: Thrombolytic and mechanical thrombectomy therapies are proven treatment methods in patients with acute stroke. Aim is to share our experience in acute stroke therapy with colleagues.

Material and methods: In this study we evaluated the patients who underwent MT or MT + IV-tPA between 2018-2019 retrospectively. Demographic features, comorbid diseases of patients, symptom onset-to-gate and symptom gate-to-puncture durations, mRS (Modified Rankin Score) and NIHSS (National Institutes of Health Stroke Scale) score, treatment method and degree of recanalization were listed.

Results: MT was applied to 29 patients, MT + bolus IV-tPA was applied to 12 patients and MT + full dose IV-tPA was applied to 7 patients. The mean age was 66 ± 15 years, arrival mRS was 2 ± 2, arrival NIHSS score was 14 ± 5, onset-to-gate duration was 185 minutes and gate-to-puncture duration was 118 minutes.

Conclusion: The rate of recanalization, functional independence and mortality were similar to the HERMES study. It was observed a higher rate of intracranial hemorrhage in patients who received bolus or full dose IV-Tpa compared to patients who underwent MT. These results have led us to question the necessity of giving bolus or full dose IV-tPA before MT. Onset-to-gate and gate-to-puncture durations were found longer than the recommended durations. Rapid and effective management of AIS patients will provide good clinical results.

Read Full Article HTML DOI: 10.29328/journal.jnnd.1001047 Cite this Article Read Full Article PDF

Keywords:

Acute stroke; Endovascular treatment

References

  1. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, et-al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003; 34: e109-137. PubMed: https://pubmed.ncbi.nlm.nih.gov/12869717/
  2. NINDS rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581-1587. PubMed: https://pubmed.ncbi.nlm.nih.gov/7477192/
  3. Hache W, Kaste M, Bluhmki E, Brozman M, Dávalos A, et al. ECASS investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008; 359: 1317-1329. PubMed: https://pubmed.ncbi.nlm.nih.gov/18815396/
  4. Powers WJ, Derdeny CP, Biller J, Coffey CS, Hoh BL, et al. American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines fort he Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46: 3020-3035. PubMed: https://pubmed.ncbi.nlm.nih.gov/26123479/
  5. Hacke W. A new DAWN for imaging-based selection in the treat- ment of acute stroke. N Engl J Med. 2018; 378: 81–83. PubMed: https://pubmed.ncbi.nlm.nih.gov/29129127/
  6. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018; 378: 708–718. PubMed: https://pubmed.ncbi.nlm.nih.gov/29364767/
  7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 372: 1019-1030. PubMed: https://pubmed.ncbi.nlm.nih.gov/25671798/
  8. Gory B, Eldesouky I, Sivan-Hoffmann R, Rabilloud M, Ong E, et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion: an observational study and systematic review. J Neurol Neurosurg Psychiatry. 2016; 87: 520-525. PubMed: https://pubmed.ncbi.nlm.nih.gov/25986363/
  9. Wardlaw JM, Murray V, Berge E, Del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2009; 4: Cd000213. PubMed: https://pubmed.ncbi.nlm.nih.gov/25072528/
  10. Azzimondi G, Bassein L, Fiorani L, Nonino F, Montaguti U, et al. Variables associated with hospital arrival time after stroke: effect of delay on the clinical efficiency of early treatment. Stroke. 1997; 28: 537-542. PubMed: https://pubmed.ncbi.nlm.nih.gov/9056608/

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