Neurointervention.  2015 Sep;10(2):51-59. 10.5469/neuroint.2015.10.2.51.

Previous and Recent Evidence of Endovascular Therapy in Acute Ischemic Stroke

• Song D
• Cho AH

• KMID: 2148994
• DOI: http://doi.org/10.5469/neuroint.2015.10.2.51

Abstract

The ideal therapy of acute ischemic stroke is achieved by early recanalization that finally leads to good clinical outcome. The recombinant intravenous tissue plasminogen activator (rtPA) within 4.5 hours was approved as an important thrombolytic treatment. However, the recanalization rate was low in patients with a large artery occlusion. The efficacy of intravenous rtPA regarding recanalization of a large artery occlusion was limited. In several clinical trials, pharmacological and mechanical intra-arterial thrombolytic therapy showed improved recanalization rates, but the favorable outcome had not been achieved. Through those trials and errors, researchers have learned that speed of treatment initiation, patient selection by documentation of large artery occlusion and the use of effective devices could be crucial for good clinical outcomes. Finally, five recent randomized controlled trials of endovascular therapy compared to standard medical care have been published. The superiority of endovascular thrombolysis to standard medical care was proved. In this article, we reviewed previous and recent clinical evidence about endovascular thrombolytic therapy of acute ischemic stroke.

Keyword

Acute ischemic stroke; Thrombolysis; Endovascular therapy

MeSH Terms

Arteries
Humans
Patient Selection
Stroke*
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Reference

1. 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; 333:1581–1587. PMID: 7477192.

2. de Los Rios la Rosa F, Khoury J, Kissela BM, Flaherty ML, Alwell K, Moomaw CJ, et al. Eligibility for Intravenous Recombinant Tissue-Type Plasminogen Activator Within a Population: The Effect of the European Cooperative Acute Stroke Study (ECASS) III trial. Stroke. 2012; 43:1591–1595. PMID: 22442174.

3. Mazighi M, Serfaty JM, Labreuche J, Laissy JP, Meseguer E, Lavallee PC, et al. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol. 2009; 8:802–809. PMID: 19647488.

4. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke. 1998; 29:4–11. PMID: 9445320.

5. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. 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. PMID: 10591382.

6. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013; 368:893–903. PMID: 23390923.

7. Ciccone A, Valvassori L, Nichelatti M, Sgoifo A, Ponzio M, Sterzi R, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013; 368:904–913. PMID: 23387822.

8. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013; 368:914–923. PMID: 23394476.

9. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 372:11–20. PMID: 25517348.

10. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015; 372:1009–1018. PMID: 25671797.

11. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372:1019–1030. PMID: 25671798.

12. Hacke W. Interventional thrombectomy for major stroke--a step in the right direction. N Engl J Med. 2015; 372:76–77. PMID: 25517349.

13. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015; 372:2296–2306. PMID: 25882510.

14. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015; 372:2285–2229. PMID: 25882376.

15. Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988; 19:1216–1222. PMID: 3176080.

16. del Zoppo GJ, Ferbert A, Otis S, Bruckmann H, Hacke W, Zyroff J, et al. Local intra-arterial fibrinolytic therapy in acute carotid territory stroke. A pilot study. Stroke. 1988; 19:307–331. PMID: 3354013.

17. Zeumer H, Freitag HJ, Zanella F, Thie A, Arning C. Local intraarterial fibrinolytic therapy in patients with stroke: Urokinase versus recombinant tissue plasminogen activator (r-tPA). Neuroradiology. 1993; 35:159–162. PMID: 8433796.

18. Ogawa A, Mori E, Minematsu K, Taki W, Takahashi A, Nemoto S, et al. Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke. 2007; 38:2633–2639. PMID: 17702958.

19. Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, et al. Combined intravenous and intra-arterial r-tPA versus intra-arterial therapy of acute ischemic stroke: Emergency management of stroke (EMS) bridging trial. Stroke. 1999; 30:2598–2605. PMID: 10582984.

20. Investigators IMS Study. Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the interventional management of stroke study. Stroke. 2004; 35:904–911. PMID: 15017018.

21. Investigators II Trial investigators. The interventional management of stroke (IMS) II study. Stroke. 2007; 38:2127–2135. PMID: 17525387.

22. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: Final results of the Multi MERCI trial. Stroke. 2008; 39:1205–1212. PMID: 18309168.

23. Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009; 40:2761–2768. PMID: 19590057.

24. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012; 380:1241–1249. PMID: 22932715.

25. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al. TREVO versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012; 380:1231–1240. PMID: 22932714.

26. Khatri P, Yeatts SD, Mazighi M, Broderick JP, Liebeskind DS, Demchuk AM, et al. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol. 2014; 13:567–574. PMID: 24784550.

27. van den Berg LA, Koelman DL, Berkhemer OA, Rozeman AD, Fransen PS, Beumer D, et al. Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke. Stroke. 2015; 46:1257–1262. PMID: 25851766.

28. Fransen PS, Beumer D, Berkhemer OA, van den Berg LA, Lingsma H, van der Lugt A, et al. MR CLEAN, a multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands: study protocol for a randomized controlled trial. Trials. 2014; 15:343. PMID: 25179366.

29. Grotta JC, Hacke W. Stroke neurologist's Perspective on the New Endovascular Trials. Stroke. 2015; 46:1447–1452. PMID: 25944328.

30. Menon BK, Campbell BC, Levi C, Goyal M. Role of imaging in current acute ischemic stroke workflow for endovascular therapy. Stroke. 2015; 46:1453–1461. PMID: 25944319.