Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care

doi:10.1016/j.jacc.2015.12.077

Review

. 2016 Jun 7;67(22):2645-55.

doi: 10.1016/j.jacc.2015.12.077.

Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care

Maxim Mokin¹, Kenneth V Snyder², Adnan H Siddiqui³, Elad I Levy⁴, L Nelson Hopkins⁵

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, Tampa, Florida.
² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York. Electronic address: lhopkins@ubns.com.

PMID: 27256836
DOI: 10.1016/j.jacc.2015.12.077

Free article

Review

Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care

Maxim Mokin et al. J Am Coll Cardiol. 2016.

Free article

. 2016 Jun 7;67(22):2645-55.

doi: 10.1016/j.jacc.2015.12.077.

Authors

Maxim Mokin¹, Kenneth V Snyder², Adnan H Siddiqui³, Elad I Levy⁴, L Nelson Hopkins⁵

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, Tampa, Florida.
² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York. Electronic address: lhopkins@ubns.com.

PMID: 27256836
DOI: 10.1016/j.jacc.2015.12.077

Abstract

Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 "positive" trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines. We discuss the ongoing and future changes in stroke systems of care, with an emphasis on the role of pre-hospital stroke triage, interhospital transfer, and the 2 main levels of stroke center certification (primary and comprehensive).

Keywords: acute ischemic stroke; endovascular therapy; randomized clinical trials; stroke centers; thrombectomy.

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Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care

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Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care

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