title: Endovascular treatment of acute ischemic stroke: Honolulu shock and thereafter.
abstract: Recently, use of mechanical clot retrievers for acute stroke has gradually spread. However, 3 recent randomized controlled trials failed to show superiority of endovascular treatment compared to intravenous recombinant tissue plasminogen activator (IV rt-PA) alone or standard care. On the other hand, a Japanese nationwide survey demonstrated the efficacy of endovascular treatment in the IV rt-PA failed and ineligible patients, especially with the proximal artery occlusion such as the internal carotid artery. Earlier initiation and higher reperfusion of endovascular treatment seemed to be the main reason for the better result in this survey compared with the reported randomized studies. Because next-generation devices such as stent retrievers have been shown to provide better effects in terms of clinical outcomes compared with the Merci retriever, the efficacy of endovascular treatment is expected to be confirmed again by randomized controlled trials in the near future.
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Electronic address: shinichiyoshimura@hotmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shirakawa
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Yasue
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Shindo
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute stroke; clot retriever; randomized trial; tissue plasminogen activator