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Chapter 6 - Endovascular Therapy

Published online by Cambridge University Press:  28 October 2019

Mary Carter Denny
Affiliation:
Georgetown University Hospital
Ahmad Riad Ramadan
Affiliation:
Henry Ford Hospital, Detroit
Sean I. Savitz
Affiliation:
University of Texas Health Science Center, Houston
James Grotta
Affiliation:
Memorial Hermann Texas Medical School
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Summary

When used alone, intravenous and intra-arterial thrombolysis have yielded low recanalization rates of proximal large-vessel occlusions (LVO). The endovascular trials utilizing first-generation devices such as the Merci retriever and the Penumbra aspiration system were essentially neutral and failed to demonstrate superiority of mechanical thrombectomy over IV tPA (MR RESCUE, SYNTHESIS, IMS-III). In 2015, however, six trials – MR CLEAN, EXTEND-IA, SWIFT PRIME, ESCAPE, REVASCAT, and THRACE – led to a fundamental shift in how we acutely manage LVOs today. All six trials compared endovascular thrombectomy (EVT) to IV tPA alone and demonstrated clear superiority of thrombectomy in patients presenting within 6 hours from the time they were last known well (LKW) if they met specific imaging criteria.

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Chapter
Information
Acute Stroke Care , pp. 80 - 100
Publisher: Cambridge University Press
Print publication year: 2019

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References

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