title: Evolution of acute ischemic stroke therapy from lysis to thrombectomy: Similar or different to acute myocardial infarction?
abstract: Acute ischemic stroke remains a major global cause of death, permanent disability, and dementia. For nearly two decades, intravenous tissue plasminogen activator (tPA) has been the only recommended therapy, albeit administered within the recommended time window (i.e., <4.5h). However, intravenous tPA is associated with modest recanalization rates, with a majority of patients having poor functional outcomes despite timely administration. Endovascular therapy has recently been introduced as adjunctive management of acute ischemic stroke. First generation endovascular thrombectomy devices have failed to improve outcomes compared with intravenous tPA. However, recent randomized trials utilizing stent retrievers demonstrated that these devices improve functional outcomes in patients with acute ischemic stroke secondary to large-artery occlusion. Introduction of stent retrieves has begun a new era for acute ischemic stroke therapy. This comprehensive review discusses the evolution of acute ischemic stroke therapy over the last two decades, with emphasis on recent randomized trials evaluating stent retrievers. Additionally, similarities and differences between the evolution of therapy in ST elevation myocardial infarction and acute ischemic stroke will be highlighted.
authors: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: islam.elgendy@medicine.ufl.edu.
authors: Islam Y
authors: IY
authors: Elgendy
authors: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: ahmed.mahmoud@medicine.ufl.edu.
authors: Ahmed N
authors: AN
authors: Mahmoud
authors: Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, USA. Electronic address: hmansoor@ufl.edu.
authors: Hend
authors: H
authors: Mansoor
authors: Department of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: mohammad.mojadidi@medicine.ufl.edu.
authors: Mohammad K
authors: MK
authors: Mojadidi
authors: Department of Medicine, University of Florida, Gainesville, FL, USA; North Florida/South Georgia Veterans Health System, Gainesville, FL, USA. Electronic address: Anthony.bavry@medicine.ufl.edu.
authors: Anthony A
authors: AA
authors: Bavry
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods / Q000639:trends*; D015912:Thrombolytic Therapy / Q000379:methods / Q000639:trends*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Ischemic; Myocardial infarction; Stroke; Thrombectomy; Thrombolysis