Beyond tissue plasminogen activator: mechanical intervention in acute stroke.
Mechanical interventions in acute ischemic stroke promise to provide emergency physicians with tools to treat patients in whom conventional thrombolysis might be ineffective or contraindicated, including most patients with stroke who arrive at the emergency department beyond the 3-hour time window for intravenous tissue plasminogen activator. A systematic MEDLINE literature review was performed. Endovascular interventions currently in early human clinical trials include the use of lasers, ultrasonography, angioplasty, microsnares, and a variety of clot-retrieval devices. Potential advantages of these approaches include more rapid recanalization of occluded vessels, reduced or no exposure to fibrinolytic agents, and a longer treatment window. Early safety trials are promising, with serial improvements in device design to minimize trauma to cerebrovascular endothelium and accelerate vessel recanalization. The purpose of this review is to provide the emergency medicine community with an understanding of these promising and emerging approaches to acute stroke therapy.
Leary
Megan C
MC
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mleary@caregroup.harvard.edu
Saver
Jeffrey L
JL
Gobin
Y Pierre
YP
Jahan
Reza
R
Duckwiler
Gary R
GR
Vinuela
Fernando
F
Kidwell
Chelsea S
CS
Frazee
John
J
Starkman
Sidney
S
D000800:Angioplasty, Balloon / Q000295:instrumentation; D002404:Catheterization / Q000295:instrumentation; D003328:Coronary Thrombosis / Q000628:therapy; D005112:Extracorporeal Circulation; D006801:Humans; D053685:Laser Therapy; D020521:Stroke / Q000628:therapy*; D014464:Ultrasonic Therapy; D018084:Ultrasonography, Interventional / Q000295:instrumentation; D014656:Vascular Surgical Procedures / Q000295:instrumentation*