Neurol. praxi. 2014;15(3):125-130

Recanalization therapy of ischemic stroke - what next?

doc. MUDr. David Školoudík, Ph.D., FESO
Fakulta zdravotnických věd a Lékařská fakulta Univerzity Palackého v Olomouci
Neurologická klinika, Fakultní nemocnice Ostrava

Acute occlusion of the cervical or intracranial cerebral artery is the most common cause of ischemic stroke. Early arterial recanalization with brain reperfusion is currently the most effective method of treatment of ischemic stroke. The gold standard of stroke reperfusion therapy is na intravenous thrombolysis with administration of 0.9 mg/kg tPA in hourly infusion. Intra-arterial thrombolysis and different mechanical recanalization methods of cerebral arteries including sonolysis are alternative treatment especially for patients who have failed systemic thrombolysis (recanalization of the artery) or a thrombolysis was contraindicated. Despite the rapid development of recanalization methods, their effectiveness remains limited not only therapeutic window, numerous contraindications, but also the fact that despite successful early recanalization of the artery only about 50–60 % of treated patients reach independency within 3 months. For these reasons it is necessary to look for other therapeutic approaches in the future.

Keywords: ischemic stroke, arterial occlusion, recanalization, therapy, sonolysis

Published: June 9, 2014  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Školoudík D. Recanalization therapy of ischemic stroke - what next? Neurol. praxi. 2014;15(3):125-130.
Download citation

References

  1. Bar M, Mikulík R, Krajina A, Jonszta T, Krajina A, Krajina A, Roubec M, Skoloudik D, Prochazka V. Diagnosis of Recanalization of Intracranial Artery Has Poor Inter-Rater Variability. Am J Neuroradiol 2012; 33: 972-974. Go to original source... Go to PubMed...
  2. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, Jauch EC, Jovin TG, Yan B, Silver FL, von Kummer R, Molina CA, Demaerschalk BM, Budzik R, Clark WM, Zaidat OO, Malisch TW, Goyal M, Schonewille WJ, Mazighi M, Engelter ST, Anderson C, Spilker J, Carrozzella J, Ryckborst KJ, Janis LS, Martin RH, Foster LD, Tomsick TA; Interventional Management of Stroke (IMS) III Investigators. Interventional Management of Stroke (IMS) III Investigators. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368: 893-903. Go to original source... Go to PubMed...
  3. Davalos A, Pereira VM, Chapot R, Bonafé A, Andersson T, Gralla J; Solitaire Group. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 2012; 43: 2699-2705. Go to original source... Go to PubMed...
  4. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ichaemic attack. Cerebrovasc Dis 2008; 25: 457-507. Go to original source... Go to PubMed...
  5. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study: a randomized controlled trial: Prolyse in Acute Cerebral Thromboembolism. JAMA 1999; 282: 2003-2011. Go to original source... Go to PubMed...
  6. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D. for the ECASS 3 Investigators. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. N Engl J Med 2008; 359: 1317-1329. Go to original source... Go to PubMed...
  7. Jansen O, Brueckmann H. Interventional Stroke Therapy. Stuttgart, Germany: Georg Thieme Verlag, 2013: 1-204. Go to original source...
  8. Koh JS, Lee SJ, Ryu CW, Kim HS. Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: a systematic review. Neurointervention 2012; 7: 1-9. Go to original source... Go to PubMed...
  9. Mazighi M, Chaudhry SA, Ribo M, Khatri P, Skoloudik D, Mokin M, Labreuche J, Meseguer E, Yeatts SD, Siddiqui AH, Broderick J, Molina CA, Qureshi AI, Amarenco P. Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation. 2013; 127: 1980-1985. Go to original source... Go to PubMed...
  10. Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallée PC, Cabrejo L, Slaoui T, Guidoux C, Lapergue B, Klein IF, Olivot JM, Abboud H, Simon O, Niclot P, Nifle C, Touboul PJ, Raphaeli G, Gohin C, Claeys ES, Amarenco P; RECANALISE investigators. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. REcanalisation using Combined intravenous Alteplase and Neurointerventional ALgorithm for acute Ischemic StrokE (RECANALISE). Lancet Neurol 2009; 8: 802-809. Go to original source... Go to PubMed...
  11. Ringelstein EB, Thijs V, Norrving B, Chamorro A, Aichner F, Grond M, Saver J, Laage R, Schneider A, Rathgeb F, Vogt G, Charissé G, Fiebach JB, Schwab S, Schäbitz WR, Kollmar R, Fisher M, Brozman M, Skoloudik D, Gruber F, Serena Leal J, Veltkamp R, Köhrmann M, Berrouschot J. AXIS 2 Investigators. Granulocyte colony-stimulating factor in patients with acute ischemic stroke: results of the AX200 for Ischemic Stroke trial. Stroke. 2013; 44: 2681-2687. Go to original source... Go to PubMed...
  12. Saqqur M, Tsivgoulis G, Nicoli F, Skoloudik D, Sharma VK, Larrue V, Eggers J, Perren F, Charalampidis P, Storie D, Shuaib A, Alexandrov AV. The Role of Sonolysis and Sonothrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Case-Control Studies. J Neuroimaging. 2013 Apr 22. [Epub ahead of print] Go to original source... Go to PubMed...
  13. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP; Multi MERCI Investigators, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 2008; 39: 1205-1212. Go to original source... Go to PubMed...
  14. Školoudik D, Bar M, Mikulik R, Neumann J, Václavík D, Herzig R, Škoda O, Kalita Z, Šaňák D, Polívka J. Doporučeni pro systemovou trombolyzu u pacientů s akutnim mozkovym infarktem. Čes a Slov Neurol Neurochir 2006; 2: 151-156.
  15. Školoudík D, Kuliha M, Jonszta T, Herzig R. Endovaskulární léčba ischemické cévní mozkové příhody. Cesk Slov Neurol N 2012; 75: 669-683.
  16. Školoudík D, Šaňák D. Rekanalizační terapie akutní ischemické cévní mozkové příhody. Praha: Maxdorf Jessenius 2013: 1-306.
  17. Thijs VN, Peeters A, Vosko M, Aichner F, Schellinger PD, Schneider D, Neumann-Haefelin T, Röther J, Davalos A, Wahlgren N, Verhamme P. Randomized, placebo-controlled, dose-ranging clinical trial of intravenous microplasmin in patients with acute ischemic stroke. Stroke 2009; 40: 3789-3795. Go to original source... Go to PubMed...
  18. Tissue Plasminogen Activator for Acute Ischemic Stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995; 333: 1581-1588. Go to original source... Go to PubMed...
  19. Volný O, Mikulík R. Kolaterální cirkulace mozku - potenciální cíl terapie mozkových infarktů. Cesk Slov Neurol N 2013; 76: 307-314.




Neurology for Practice

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.