Reperfusion Therapy in Acute Ischemic Stroke
Bhaskar et al. BMC Neurology (2018) 18:8 DOI 10.1186/s12883-017-1007-y REVIEW Open Access Reperfusion therapy in acute ischemic stroke: dawn of a new era? Sonu Bhaskar1,2,3,4,6,7* , Peter Stanwell7, Dennis Cordato2,4,5, John Attia7,8 and Christopher Levi1,2,3,4,5,6* Abstract Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). In this paper, we present an extensive overview of intravenous and endovascular reperfusion strategies, recent advances in AIS neurointervention, limitations of various treatment paradigms, and provide insights on imaging-guided reperfusion therapies. A roadmap for imaging guided reperfusion treatment workflow in AIS is also proposed. Both systemic thrombolysis and endovascular treatment have been incorporated into the standard of care in stroke therapy. Further research on advanced imaging- based approaches to select appropriate patients, may widen the time-window for patient selection and would contribute immensely to early thrombolytic strategies, better recanalization rates, and improved clinical outcomes. Keywords: Stroke, Reperfusion therapy, Prognosis, Endovascular treatment, Neurointervention Background and up to 6–8 h for endovascular MT. The restriction on An overwhelming number of studies and clinical trials con- IV-tPA treatment beyond 4.5 h disqualifies the majority of firmtheefficacyofthrombolytictherapy,inagiventhera- stroke patients admitted beyond this time-window (around peutic window, in improving the clinical outcome and 85%), thereby drastically limiting the eligible population [7– recovery of acute ischemic stroke (AIS) patients [1–5]. The 10]. primary therapeutic goal for patients with AIS is the timely In this article, we review the literature on the various restoration of blood flow to salvageable ischemic brain reperfusion strategies available for AIS patients, and pro- tissue that is not already infarcted [6].
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