Abstract
The only effective treatment licensed for acute ischaemic stroke is intravenous thrombolysis within 4.5 hours from stroke onset. An alternative method of restoring blood flow is mechanical thrombectomy (MT). Although this is highly effective at recanalization, it remains unclear whether it is more effective than thrombolysis in improving clinical outcomes.
This review examines key clinical outcomes from published studies and reviews ongoing studies to identify devices, patient population, and stated outcomes of MT. We discuss the issues when comparing clinical outcomes from different trials and suggest measures to help standardize reporting.
We used routine review methodology to search relevant databases for stroke and MT published between 1999 – 2012 and active trials between August 2011 - May 2012.
The studies in this review had an overall patient population of 8354. The most widely used primary outcome (94% of studies) was successful recanalization. The mean mortality across the studies was 17% (range 7 - 44), 64% of studies reported neurological improvement and 97% reported functional outcome with 42% (range 15 - 54)] achieving independence in activities of daily living. Mean symptomatic intracerebral haemorrhage was 11% (range 0 – 45%). There were significant differences in outcome reporting between studies.
Evidence from published studies shows a strong relationship between recanalization and good outcomes although nonstandardization makes comparisons difficult. There is a trend towards higher recanalization, lower mortality, and better functional outcome in more recent studies. To examine effectiveness of MT vs thrombolysis, randomized controlled trials are needed. Several are currently in progress but it remains to be seen if procedures and outcomes are reported in a standardized manner.
Keywords: Stroke, thrombectomy, ischaemic, endovascular treatment, thrombus, recanalization.
CNS & Neurological Disorders - Drug Targets
Title:Mechanical Thrombectomy in Acute Ischaemic Stroke: A Review of the Literature, Clinical Effectiveness and Future Use
Volume: 12 Issue: 2
Author(s): Frank Lally, Iris Q. Grunwald, Ranjan Sanyal, Indira Natarajan and Christine Roffe
Affiliation:
Keywords: Stroke, thrombectomy, ischaemic, endovascular treatment, thrombus, recanalization.
Abstract: The only effective treatment licensed for acute ischaemic stroke is intravenous thrombolysis within 4.5 hours from stroke onset. An alternative method of restoring blood flow is mechanical thrombectomy (MT). Although this is highly effective at recanalization, it remains unclear whether it is more effective than thrombolysis in improving clinical outcomes.
This review examines key clinical outcomes from published studies and reviews ongoing studies to identify devices, patient population, and stated outcomes of MT. We discuss the issues when comparing clinical outcomes from different trials and suggest measures to help standardize reporting.
We used routine review methodology to search relevant databases for stroke and MT published between 1999 – 2012 and active trials between August 2011 - May 2012.
The studies in this review had an overall patient population of 8354. The most widely used primary outcome (94% of studies) was successful recanalization. The mean mortality across the studies was 17% (range 7 - 44), 64% of studies reported neurological improvement and 97% reported functional outcome with 42% (range 15 - 54)] achieving independence in activities of daily living. Mean symptomatic intracerebral haemorrhage was 11% (range 0 – 45%). There were significant differences in outcome reporting between studies.
Evidence from published studies shows a strong relationship between recanalization and good outcomes although nonstandardization makes comparisons difficult. There is a trend towards higher recanalization, lower mortality, and better functional outcome in more recent studies. To examine effectiveness of MT vs thrombolysis, randomized controlled trials are needed. Several are currently in progress but it remains to be seen if procedures and outcomes are reported in a standardized manner.
Export Options
About this article
Cite this article as:
Lally Frank, Grunwald Iris Q., Sanyal Ranjan, Natarajan Indira and Roffe Christine, Mechanical Thrombectomy in Acute Ischaemic Stroke: A Review of the Literature, Clinical Effectiveness and Future Use, CNS & Neurological Disorders - Drug Targets 2013; 12 (2) . https://dx.doi.org/10.2174/18715273112119990054
DOI https://dx.doi.org/10.2174/18715273112119990054 |
Print ISSN 1871-5273 |
Publisher Name Bentham Science Publisher |
Online ISSN 1996-3181 |
Call for Papers in Thematic Issues
Heart and Brain Axis Targets in CNS Neurological Disorders
Recently there has been a surge of interest in delving deeper into the complex interplay between the heart and brain. This fascination stems from a growing recognition of the profound influence each organ holds over the other, particularly in the realm of central nervous system (CNS) neurological disorders. The purpose ...read more
Lifestyle Interventions to Prevent and Treat Cognitive Impairment and Dementia
More than 55 million people live with dementia worldwide. By 2050, the population affected by dementia will exceed 139 million individuals. Mild cognitive impairment (MCI) is a pre-dementia stage, also known as prodromal dementia, affecting older adults. MCI emerges years before the manifestation of dementia but can be avoidable and ...read more
Pathogenic Proteins in Neurodegenerative Diseases: From Mechanisms to Treatment Modalities
The primary objective of this thematic issue is to elucidate the molecular mechanisms by which pathogenic proteins contribute to neurodegenerative diseases and to highlight current and emerging therapeutic strategies aimed at mitigating their effects. By bringing together cutting-edge research and reviews, this issue aims to: 1.Enhance Understanding: Provide a comprehensive ...read more
Role of glial cells in autism spectrum disorder: Molecular mechanism and therapeutic approaches
Emerging evidence suggests that glial cells may play a pivotal role in neuroanatomical and behavioral changes found in autism spectrum disorder (ASD). Many individuals with ASD experience a neuro-immune system abnormalities throughout life, which implicates a potential role of microglia in the pathogenesis of ASD. Dysfunctional astrocytes and oligodendrocytes were ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Free Radicals and Oxidative Stress: Signaling Mechanisms, Redox
Basis for Human Diseases, and Cell Cycle Regulation
Current Molecular Medicine Matrix Metalloproteinases: A Potential Therapeutic Target in Atherosclerosis
Current Drug Targets - Cardiovascular & Hematological Disorders What We Learnt from Randomized Clinical Trials and Cohort Studies of Antioxidant Vitamin? : Focus on Vitamin E and Cardiovascular Disease
Current Pharmaceutical Biotechnology Editorial (Thematic Issue: Angiogenesis in the Development of Cardiovascular Diseases)
Current Angiogenesis (Discontinued) Cardiometabolic Risk Related to the Association of hypertriglyceridemia-Low HDLc
Current Pharmaceutical Design Amide-linked Ethanolamine Conjugate of Gemfibrozil as a Profound HDL Enhancer: Design, Synthesis, Pharmacological Screening and Docking Study
Current Drug Discovery Technologies Biochemical Markers of Cardiovascular Damage from Tobacco Smoke
Current Pharmaceutical Design Sarcoidosis in Pregnancy and Postpartum Period
Current Respiratory Medicine Reviews Renal Microcirculation and Calcium Channel Subtypes
Current Hypertension Reviews Gender Disparities on Access to Care and Coronary Disease Management
Current Pharmaceutical Design Dapsone, More than an Effective Neuro and Cytoprotective Drug
Current Neuropharmacology Pulmonary Vasodilators in the Management of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery
Current Vascular Pharmacology Lipoprotein(a): Current Perspectives
Current Vascular Pharmacology Aging and Remodeling During Healing of the Wounded Heart: Current Therapies and Novel Drug Targets
Current Drug Targets Therapeutic Targets for Management of Periodontitis and Diabetes
Current Pharmaceutical Design Redox-Active Selenium in Health and Disease: A Conceptual Review
Mini-Reviews in Medicinal Chemistry GPER and ER: Estrogen Receptors with Distinct Biological Roles in Breast Cancer
Immunology, Endocrine & Metabolic Agents in Medicinal Chemistry (Discontinued) Ivabradine for Treatment of Coronary Artery Disease: From Last Chance Resort to Mainstem of a Reasoned Therapy
Cardiovascular & Hematological Agents in Medicinal Chemistry Will Antirheumatic Treatment Improve Cardiovascular Outcomes in Patients with Rheumatoid Arthritis?
Current Pharmaceutical Design Oral Antiplatelet Therapy for Acute Coronary Syndromes: Aspirin, P2Y12 Inhibition and Thrombin Receptor Antagonists
Current Drug Targets