The Trials and Tribulations of Ischemic Stroke Therapy

Author(s): Arani Bose, Sophia S. Kuo, Jennifer Wong, John Lockhart and Siu Po Sit

Pp: 511-528 (18)

* (Excluding Mailing and Handling)

Abstract

In this chapter, we focus on the recently published randomized controlled trials examining combined endovascular therapy with IV tPA versus IV tPA alone. In October 2014, the first evidence was presented from a randomized clinical trial conducted in the Netherlands showing the benefit of endovascular therapy in acute ischemic stroke secondary to emergent large vessel occlusion in the anterior circulation. Four randomized controlled trials later confirmed these results. The advances in techniques and devices which enabled these positive findings for intraarterial therapy, including aspiration thrombectomy, stent retrievers, and combination strategies will be discussed herein. We will also consider where opportunities remain to maximize favorable outcomes while minimizing costs as these recent trial results are translated into clinical practice.

Keywords: Acute ischemic stroke, Endovascular therapy, Intra-arterial therapy, Mechanical thrombectomy, Randomized clinical trial, Reperfusion catheter, Stent retriever.

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