Výsledky intervenčních studií MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA, REVASCAT


Authors: O. Volný 1,2;  A. Krajina 3;  M. Bar 4;  R. Herzig 5;  D. Šaňák 6;  A. Tomek 7;  D. Školoudík 8;  F. Charvát 9;  D. Václavík 10;  J. Neumann 11,12;  O. Škoda 13,14;  R. Mikulík 1,2
Authors‘ workplace: ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 1;  I. neurologická klinika LF MU a FN u sv. Anny v Brně 2;  Komplexní cerebrovaskulární centrum, Radiologická klinika LF UK a FN Hradec Králové 3;  Neurologická klinika LF OU a FN Ostrava 4;  Komplexní cerebrovaskulární centrum, Neurologická klinika LF UK a FN Hradec Králové 5;  Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc 6;  Neurologická klinika 2. LF UK a FN v Motole, Praha 7;  Ústav ošetřovatelství, FZV, UP v Olomouci 8;  Radiodiagnostické oddělení, ÚVN – VFN Praha 9;  Vzdělávací a výzkumný institut Agel, Neurologické oddělení, Vítkovická nemocnice, a. s., Ostrava 10;  Iktové centrum, Neurologické oddělení, Krajská zdravotní, a. s., Nemocnice Chomutov 11;  Neurologická klinika LF UK a FN Plzeň 12;  Iktové centrum, Neurologické oddělení, Nemocnice Jihlava 13;  Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha 14
Published in: Cesk Slov Neurol N 2016; 79/112(1): 100-110
Category: Guidelines
doi: https://doi.org/10.14735/amcsnn2016100

Overview

For the first time in cerebrovascular neurology there is an indisputable evidence of clinical effectiveness of mechanical recanalization in acute cerebral artery occlusion. Five randomized trials published in 2015 documented an unprecedented benefit and safety of endovascular thrombectomy. The particular trials were: MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA and REVASCAT. It has been proven that endovascular treatment reduces morbidity and mortality of patients significantly. The number needed to treat to result in one patient with good functional outcome was staggeringly low – only 3–7 patients. Age and deficit severity do not constitute exclusionary criteria (MR CLEAN, ESCAPE and EXTEND-IA without age restrictions; SWIFT PRIME between 18–80 years and REVASCAT between 18–85 years of age). The principal imaging methods were predominantly native CT and CT angiography. Perfusion methods were used in EXTEND-IA and SWIFT PRIME. The objective of endovascular treatment was to achieve reperfusion within 60 min after groin puncture. An essential part of the trials was a performance evaluation system. We provide information on the results of thrombectomy trials, summarize management during thrombectomy (correction of blood pressure, use of anesthesia, concomitant medication) and propose indication criteria.

Key words:
stroke –  endovascular thrombectomy –  neurointerventions –  imaging –  acute care management –  quality monitoring

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Mishra SM, Dykeman J, Sajobi TT, Trivedi A, Almekhlafi M, Sohn SI et al. Early reperfusion rates with IV tPA are determined by CTA clot characteristics. AJNR Am J Neuroradiol 2014; 35(12): 2265– 2272. doi: 10.3174/ ajnr.A4048.

2. Riedel CH, Zim­mermann P, Jensen-Konder­ing U, Stingele R, Deuschl G, Jansen O. The importance of size: succes­sful recanalization by intravenous thrombol­ysis in acute anterior stroke depends on thrombus length. Stroke 2011; 42(6): 1775– 1777. doi: 10.1161/ STROKEAHA.110.609693.

3. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368(13): 893– 903. doi: 10.1056/ NEJMoa1214300.

4. Ciccone A, Valvas­sori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904– 913. doi: 10.1056/ NEJMoa1213701.

5. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z et al. A trial of imag­ing selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368(10): 914– 923. doi: 10.1056/ NEJMoa1212793.

6. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al. A randomized trial of intraarterial treatmentfor acute ischemic stroke. N Engl J Med 2015; 372(1): 11– 20. doi: 10.1056/ NEJMoa1411587.

7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton et al.Randomized as­ses­sment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019– 1030. doi: 10.1056/ NEJMoa1414905.

8. Saver JL, Goyal M, Bonafe A, Diener HCh, Levy EI, Pereira VM et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285– 2295. doi: 10.1056/ NEJMoa1415061.

9. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yas­si N et al. Endovascular therapy for ischemic stroke with perfusion-imag­ing selection. N Engl J Med 2015; 372(11): 1009– 1018. doi: 10.1056/ NEJMoa1414792.

10. Jovin TG, Chamor­ro A, Cobo E, Miquel AM, Molina CA, Rovira A et al. Thrombectomy within 8 hours after symp­tom onset in ischemic stroke. N Engl J Med 2015; 372: 2296– 2306. doi: 10.1056/ NEJMoa1503780.

11. Nambiar V, Sohn SI, Almekhlafi MA, Chang HW, Mishra S, Qazi E et al. CTA col­lateral status and response to recanalization in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2014; 35(5): 884– 890. doi: 10.3174/ ajnr.A3817.

12. Menon BK, Campbell BC, Levi C, Goyal M. Role of imag­ing in cur­rent acute ischemic stroke workflow for endovascular therapy. Stroke 2015; 46(6): 1453– 1461. doi: 10.1161/ STROKEAHA.115.009160.

13. Almekhlafi MA, Mishra S, Desai JA, Nambiar V, Volny O, Goel A et al. Not all „succes­sful“ angiographic reperfusion patients are an equal validation of a modified TICI scor­ing system. Interv Neuroradiol 2014; 20(1): 21– 27.

14. Powers WJ, Derdeyn CP, Bil­ler J, Cof­fey CS, Hoh BL,Jauch EC et al. American Heart As­sociation StrokeCouncil. 2015 AHA/ ASA Focused Update of the 2013 Guidelines for the 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(10): 3020– 3035. doi: 10.1161/ STR.0000000000000074.

15. Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard Ch et al. Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/ 2015, supported by ESO, ESMINT, ESNR and EAN 2015. Available from URL: http:/ / www.eso-stroke.org/ eso-stroke/ strokeinformation/ thrombectomy-consensus-eso-karolinska-esmint-esnr.html.

16. Casaubon LK, Boulanger JM, Blacquiere D, Bou-cher S, Brown K, Goddard T et al. Canadian Stroke BestPractice Recom­mendations: Hyperacute Stroke Care Guidelines, Update 2015. Int J Stroke 2015; 10(6): 924– 940. doi: 10.1111/ ijs.12551.

Labels
Paediatric neurology Neurosurgery Neurology
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