title: Saving the ischemic penumbra: endovascular thrombolysis versus medical treatment.
abstract: Endovascular thrombolysis may allow rapid arterial recanalization in patients with acute ischemic stroke. We present the first study to our knowledge comparing the ischemic penumbra saved with endovascular versus medical therapy. A retrospective review of 21 patients undergoing endovascular intervention for stroke from 2010 to 2011 was contrasted with 21 consecutive patients treated with antiplatelet agents alone. Immediate computed tomography perfusion (CTP) scan of the head and neck was obtained in all patients. Patients with lacunar and posterior circulation infarcts, and those who were medically unstable for MRI post-operatively were excluded. CTP and MRI underwent volumetric calculation. CTP penumbra was correlated with diffusion restriction volumes on MRI, and an assessment was made on the volume of ischemic burden saved with either endovascular treatment or antiplatelet agents. The median age was 70 years (interquartile range 62-80). Median National Institutes of Health Stroke Scale score was 18 and 14 in the control and endovascular groups, respectively. Intravenous tissue plasminogen activator was administered in 22 of 42 patients (52%). Median penumbra calculated was 32,808 mm(3) in the control group and 46,255 mm(3) in the endovascular group. Median penumbra spared was 9550 mm(3) (4980-18,811) in the control group versus 38,155 mm(3) in the endovascular group (p=0.0001). Endovascular thrombolysis may be more efficient than medical therapy alone in saving ischemic penumbra. Future advances in recanalization techniques will further improve the efficacy of endovascular therapy.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Zohra
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Dalyai
authors.affiliation: Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Ghobrial
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.affiliation: Department of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Flanders
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA. Electronic address: fernando.gonzalez@duke.edu.
authors.forename: L
authors.initials: L
authors.lastname: Fernando Gonzalez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: CT perfusion; Diffusion-weighted imaging; Endovascular; Penumbra; Stroke; Thrombolysis