Updates in Stroke Care

• Published in: American journal of respiratory and critical care medicine Vol. 197; no. 10; pp. 1340 - 1343
• Main Authors: Thalanayar Muthukrishnan, Prashanth, Siddiqui, Mohammed S, Baba, Ridhwan Y
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.05.2018
• Subjects: Councils; Hemorrhage; Meta-analysis; Mortality; Stroke
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201702-0413RR

Five recent randomized controlled trials (MR CLEAN [Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands], ESCAPE [Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke], REVASCAT [Randomized Trial of Revascularization with Solitaire FR Device versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting within Eight Hours of Symptom Onset], EXTEND-IA [Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial], and SWIFT PRIME [Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment]) have been conducted to better evaluate the efficacy of mechanical endovascular therapy in stroke (7-11).[...]eliminating patients with extremes of ischemic injury may affect the generalizability of the study to patients who do not meet the entry criteria of this study.Current guidelines recommend a standard dose of 0.9 mg/kg intravenous alteplase (a tPA) for acute ischemic stroke (16); however, the Japanese Pharmaceuticals and Medical Devices Agency has approved the use of 0.6 mg/kg alteplase on the basis of a study that showed similar clinical outcomes and lower risk of intracerebral hemorrhage (ICH) (17).[...]the results of ATACH-2 cannot be generalized to patients with large-volume ICH, intracranial pressure elevation, or compromised cerebral perfusion pressure, and the possibility of precipitating global or regional cerebral hypoperfusion with the intensive reduction of systolic blood pressure in such patients may still be a concern.