State of the art on acute Ischemic Stroke: late Breaking Clinical trials
Volume 4 Issue 1, pages 20-35
Received – 21 February 2018, Accepted – 01 May 2018
Director, University Institute of Diagnosis and Interventional Neuroradiology, Inselspital of the University Hospital, Bern, Switzerland.
Co-chair Stroke Center and Co-Director Clinical Trial Unit, Inselspital of the University Hospital, Bern, Switzerland..
Director of the Department of Diagnostic and Interventional Neuroradiology, University Medical Center, Hamburg-Eppendorf, Germany.
Corresponding Author: Urs Fischer – Urs.Fischer@insel.ch
This article summarizes a Medtronic-sponsored webinar held on the 29th of January 2018 in Bern, Switzerland. This webinar was moderated by Professor Jens Fiehler, and the two speakers, Professor Jan Gralla and Professor Urs Fischer, presented key data emerging from recent landmark studies evaluating endovascular treatment interventions in patients with acute anterior circulation ischemic strokes resulting from large vessel occlusion (LVO). Both speakers provided expert interpretive commentary on the significance of the latest published data. This event was streamed live, via the Oruen Ltd website, to a wide audience of interventional neuroradiologists and physicians involved in the treatment of acute ischemic stroke. The viewing audience were able to participate in a Questions and Answers session after the speakers’ presentations.
Results from the late-window DAWN and DEFUSE 3 studies were reviewed, and the implications of the outcomes achieved with thrombectomy procedures, versus standard medical therapy, in these studies, were discussed. These studies show that stroke is an ongoing continuum, and that carefully selected patients with low ischemic cores and significant mis-match can be successfully treated beyond the accepted time window of six hours since their onset of symptoms. Interventional neurologists currently face a number of unanswered questions regarding patient selection, and how and when mechanical thrombectomy procedures should be used to best effect. Interrogation of newly emergent data from recent randomized controlled trials provides insights and guidance for improving outcomes and reducing morbidity, with endovascular thrombectomy, in patients with acute ischemic stroke due to LVO.
Key words: stroke, DAWN, DEFUSE 3, endovascular thrombectomy, i.v. thrombolysis
Acknowledgements: The editorial assistance of Mr Rob Goodwin, Oruen Ltd, in the preparation of this article is acknowledged with thanks.