Endovascular Treatment of Acute Ischemic Stroke: Honolulu Shock and Thereafter

Recently, use of mechanical clot retrievers for acute stroke has gradually spread. However, 3 recent randomized controlled trials failed to show superiority of endovascular treatment compared to intravenous recombinant tissue plasminogen activator (IV rt-PA) alone or standard care. On the other hand...

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Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2014-05, Vol.23 (5), p.e295-e298
Main Authors: Yoshimura, Shinichi, MD, PhD, Shirakawa, Manabu, MD, Uchida, Kazutaka, MD, Tanaka, Yasue, MD, Shindo, Seigo, MD
Format: Article
Language:English
Subjects:
Acute stroke
Brain Ischemia - diagnosis
Brain Ischemia - therapy
Cardiovascular
clot retriever
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Fibrinolytic Agents - administration & dosage
Humans
Infusions, Intravenous
Neurology
Prosthesis Design
Randomized Controlled Trials as Topic
randomized trial
Research Design
Stents
Stroke - diagnosis
Stroke - therapy
Thrombolytic Therapy
Time Factors
tissue plasminogen activator
Treatment Outcome
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Summary:Recently, use of mechanical clot retrievers for acute stroke has gradually spread. However, 3 recent randomized controlled trials failed to show superiority of endovascular treatment compared to intravenous recombinant tissue plasminogen activator (IV rt-PA) alone or standard care. On the other hand, a Japanese nationwide survey demonstrated the efficacy of endovascular treatment in the IV rt-PA failed and ineligible patients, especially with the proximal artery occlusion such as the internal carotid artery. Earlier initiation and higher reperfusion of endovascular treatment seemed to be the main reason for the better result in this survey compared with the reported randomized studies. Because next-generation devices such as stent retrievers have been shown to provide better effects in terms of clinical outcomes compared with the Merci retriever, the efficacy of endovascular treatment is expected to be confirmed again by randomized controlled trials in the near future.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2013.12.039