14. Comparison of protocol- Randomised (Intervention
Vs Standard medical therapy)
• Documented MVO.- ICA, MCA (M1, M2)
• Time based: 6 hrs (initiation of IA therapy)-
(8 hrs – REVASCAT; 12 hrs – ESCAPE)
• Small Core - CT ASPECTS ≥ 6
• CTP – EXTEND IA; SWIFT PRIME
• Predominantly stent retrievers.
• 86.1 to 100% (100 % in EXTEND IA & SWIFT PRIME)
• (NIHSS scores were 17 (interquartile range, 13–21)
26. AHA/ ASA guideline 2015:
Patients should receive endovascular therapy with a stent
retriever if they meet all the following criteria (Class I; Level of
Evidence A). (New recommendation):
prestroke mRS score 0 to 1
acute ischemic stroke receiving intravenous r-tPA within 4.5
hours of onset
causative occlusion of the internal carotid artery or proximal
MCA (M1)
age ≥18 years
NIHSS score of ≥6
ASPECTS of ≥ 6
treatment can be initiated (groin puncture) within 6 hours of
symptom onset
27. AHA/ ASA guideline:
Carefully selected patients with anterior circulation occlusion
who have contraindications to intravenous r-tPA, endovascular
therapy with stent retrievers completed within 6 hours of
stroke onset is reasonable (Class IIa; Level of Evidence C).
Carefully selected patients with acute ischemic stroke in
whom treatment can be initiated (groin puncture) within 6
hours of symptom onset and who have causative occlusion of
the M2 or M3 portion of the MCAs, anterior cerebral arteries,
vertebral arteries, basilar artery, or posterior cerebral arteries
(Class IIb; Level of Evidence C)
Waiting after IV tPA not required (Class III)
28. Beyond 6 hours – Should you consider
MT?
ESCAPE: up to 12-hours – positive trial
6 hours
49 patients
rate ratio, 1.7; (95% CI, 0.7 to 4.0)
Not significant; however few numbers.
REVASCAT: upto 12 hours, positive trial
Data not provided.
44. Day 7
Continuous intra-arterial dilatation
Continuous Intra-arterial Dilatation With Nimodipine and Milrinone for Refractory Cerebral Vasospasm.
Anand S, Goel G, Gupta V.
J Neurosurg Anesthesiol. 2013 Jun 14. [Epub ahead of print]
58. Intracranial atherosclerosis
Intracranial arterial stenosis is responsible for 6%
to 10% of ischemic strokes in whites and 22% to
26% of ischemic strokes in Asians
SAMPRIS Trial- stenting not to be
done as routine in acute stroke
•Recurrent symptom
•Subocclusive stenosis
Ursache des ischämischen Schlaganfalls ist eine fokale Durchblutungsstörung. Wenn die Durchblutung unter 22 ml pro 100 g/min. sinkt, tritt eine Funktionsstörung auf, dies äußert sich in entsprechenden neurologischen Herdsymptomen. Nun ist es eine Frage der Zeit und der Restdurchblutung, wann das bisher nur funktionell gestörte Gewebe irreversibel geschädigt wird. Der Anteil des Gewebes, der funktionell beeinträchtigt, aber noch nicht irreversibel geschädigt ist und damit prinzipiell gerettet werden kann, bezeichnet man als Penumbra. Der größte Anteil an Penumbra-Gewebe besteht innerhalb der ersten Stunden.
Humanitarian Device: The WingspanTM Stent System with GatewayTM PTA Balloon Catheter is authorized by Federal Law for use in improving cerebral artery lumen diameter in patients with intracranial atherosclerotic disease, refractory to medical therapy, in intracranial vessels with ≥50% stenosis that are accessible to the system.
The effectiveness of this device for this use has not been demonstrated.
The Gateway PTA Balloon Catheter is indicated for balloon dilation of the stenotic portion of intracranial arteries prior to stenting for the purpose of improving intracranial perfusion.