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Mechanical Thrombectomy: Answering Unanswered

The stroke physician community witnessed a major “breakthrough” in acute stroke therapeutics when the results of the first of the many positive trials, “MR CLEAN,” were published showing a significant absolute benefit in favor of mechanical thrombectomy in patients with large vessel occlusion (LVO)....

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Autores principales: Parthasarathy, Rajsrinivas, Gupta, Vipul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001454/
https://www.ncbi.nlm.nih.gov/pubmed/32055116
http://dx.doi.org/10.4103/aian.AIAN_359_19
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author Parthasarathy, Rajsrinivas
Gupta, Vipul
author_facet Parthasarathy, Rajsrinivas
Gupta, Vipul
author_sort Parthasarathy, Rajsrinivas
collection PubMed
description The stroke physician community witnessed a major “breakthrough” in acute stroke therapeutics when the results of the first of the many positive trials, “MR CLEAN,” were published showing a significant absolute benefit in favor of mechanical thrombectomy in patients with large vessel occlusion (LVO). Thereafter, the investigators of ESCAPE, SWIFT PRIME, REVASCAT, THRACE, and PISTE concluded the same. Based on the initial studies, the American Stroke Association amended the 2013 guidelines in 2015 to include mechanical thrombectomy as the standard of care in patients with LVO presenting within six hours. In the past year, the horizon was further expanded when two major landmark trials, DAWN and DEFUSE 3, established the benefit of mechanical thrombectomy in the delayed window period in a select group of patients. It further led to the inclusion of the delayed window period treatment strategies in the 2018 guidelines. However, there are many unanswered questions in scenarios like small deficit with LVO, borderline large core, wake-up stroke (WUS), tandem occlusion, imaging of choice, conscious sedation (CS) versus general anesthesia (GA), and choice of technique. In our review, we aim to answer these questions along with a schematic representation of current techniques used in stroke thrombectomy.
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spelling pubmed-70014542020-02-13 Mechanical Thrombectomy: Answering Unanswered Parthasarathy, Rajsrinivas Gupta, Vipul Ann Indian Acad Neurol View Point The stroke physician community witnessed a major “breakthrough” in acute stroke therapeutics when the results of the first of the many positive trials, “MR CLEAN,” were published showing a significant absolute benefit in favor of mechanical thrombectomy in patients with large vessel occlusion (LVO). Thereafter, the investigators of ESCAPE, SWIFT PRIME, REVASCAT, THRACE, and PISTE concluded the same. Based on the initial studies, the American Stroke Association amended the 2013 guidelines in 2015 to include mechanical thrombectomy as the standard of care in patients with LVO presenting within six hours. In the past year, the horizon was further expanded when two major landmark trials, DAWN and DEFUSE 3, established the benefit of mechanical thrombectomy in the delayed window period in a select group of patients. It further led to the inclusion of the delayed window period treatment strategies in the 2018 guidelines. However, there are many unanswered questions in scenarios like small deficit with LVO, borderline large core, wake-up stroke (WUS), tandem occlusion, imaging of choice, conscious sedation (CS) versus general anesthesia (GA), and choice of technique. In our review, we aim to answer these questions along with a schematic representation of current techniques used in stroke thrombectomy. Medknow Publications & Media Pvt Ltd 2020 /pmc/articles/PMC7001454/ /pubmed/32055116 http://dx.doi.org/10.4103/aian.AIAN_359_19 Text en Copyright: © 2006-2019 Annals of Indian Academy of Neurology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle View Point
Parthasarathy, Rajsrinivas
Gupta, Vipul
Mechanical Thrombectomy: Answering Unanswered
title Mechanical Thrombectomy: Answering Unanswered
title_full Mechanical Thrombectomy: Answering Unanswered
title_fullStr Mechanical Thrombectomy: Answering Unanswered
title_full_unstemmed Mechanical Thrombectomy: Answering Unanswered
title_short Mechanical Thrombectomy: Answering Unanswered
title_sort mechanical thrombectomy: answering unanswered
topic View Point
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001454/
https://www.ncbi.nlm.nih.gov/pubmed/32055116
http://dx.doi.org/10.4103/aian.AIAN_359_19
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