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Review
. 2023 Dec;81(12):1030-1039.
doi: 10.1055/s-0043-1777721. Epub 2023 Dec 29.

Reperfusion therapy for acute ischemic stroke: where are we in 2023?

Sheila Cristina Ouriques Martins  1   2 , Octávio Marques Pontes-Neto  3 , Arthur Pille  1   2 , Thaís Leite Secchi  2 , Maramélia Araújo de Miranda Alves  4 , Letícia Costa Rebello  5 , Jamary Oliveira-Filho  6 , Marcos Christiano Lange  7 , Gabriel R de Freitas  8 , João Brainer Clares de Andrade  4 , Letícia Januzi de Almeida Rocha  9 , Daniel da Cruz Bezerra  10 , Ana Claudia de Souza  2 , Leonardo Augusto Carbonera  2 , Raul Gomes Nogueira  11 , Gisele Sampaio Silva  4
Affiliations
Review

Reperfusion therapy for acute ischemic stroke: where are we in 2023?

Sheila Cristina Ouriques Martins et al. Arq Neuropsiquiatr. 2023 Dec.

Abstract
in English, Portuguese

Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.

Nas últimas três décadas, o tratamento do AVC sofreu transformações significativas, impulsionadas principalmente pela introdução das terapias de reperfusão e pela organização dos serviços de AVC. Os pacientes que recebem tratamento em um serviço de AVC bem estruturado têm uma probabilidade muito maior de resultados favoráveis, diminuindo assim a incapacidade funcional e a mortalidade. Neste artigo, revisamos as evidências científicas para as terapias de reperfusão do AVC, incluindo trombólise e trombectomia e sua implementação no sistema público de saúde no Brasil.

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Conflict of interest statement

SCOM reports receiving research grant from the Ministry of Health for Resilient Trial and Resilient-Extend, Research grant from Hospital Moinhos de Vento/PROADI SUS for Resilient-Direct TNK, Resilient Extend-IV, TRIDENT and PROMOTE Study. Speaker fees from Boehringer Ingelheim, Bayer, Pfizer, Daiichi Sanchio, Novo Nordisk, Servier, Novartis, Medtronic, Penumbra, Astra Zeneca and RAPID IA. OMPN reports speaker fees from Boehringer Ingelheim, Astra Zeneca, RAPIDIA, Pfizer; Advisory board of Astra Zeneca, Boehringer Ingelheim RAPIDIA, ALLM. AP reports speaker fees from Boehringer Ingelheim. LCR reports speaker fees from Astra Zeneca and Boehringer Ingelheim. GRF reports speaker fees from Bayer and Pfizer. JBCA reports speaker fees from Astra Zeneca. ACS received a restricted grant from Boehringer Ingelheim. LAC reports receiving a restricted grant from the World Stroke Organization outside of this work and consulting and speaker fees from Allm, Astra Zeneca, Boehringer Ingelheim, and ISchemaView. RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)” trial. RGN is the Principal Investigator of the “Combined Thrombectomy for Distal MediUm Vessel Occlusion StroKe (DUSK)” trial. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, Vastrax, and Viseon. TLS, MMR, JOF, MCL, LJAR, DCB have no disclosures to declare.

Figures

Figure 1
Figure 1
Odds ratio for favorable prognosis at three months in patients treated with tPA compared with controls by the time of initiation of treatment. (Adapted from Lancet 2004 13 ).
Figure 2
Figure 2
Recanalization rates with tPA by affected segment.
Figure 3
Figure 3
Relationship between time from onset of symptoms in treatment and functional outcome (adapted from Saver, JAMA 2016 35 ).
Figure 4
Figure 4
Relationship between door-reperfusion time and functional outcome (adapted from Saver, JAMA 2016 35 ).
Figure 5
Figure 5
Main milestones in the implementation of reperfusion therapy in Brazil.
See this image and copyright information in PMC

References

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