Mechanical Thrombectomy in Stroke

TY - JOUR

T1 - Mechanical Thrombectomy in Stroke

AU - Fiehler, Jens

AU - Gerloff, Christian

PY - 2015/12/4

Y1 - 2015/12/4

N2 - BACKGROUND: The introduction of neurological stroke units and of thrombolysis with the intravenous (IV) administration of recombinant tissue-type plasminogen activator (tPA) have markedly improved the treatment of stroke. Five randomized trials of catheter-based interventional treatment of stroke with special stents were published in 2015.METHODS: Recently published randomized trials of mechanical thrombectomy are selectively reviewed.RESULTS: These trials documented the clinical efficacy of mechanical thrombectomy (MT) in the treatment of occlusion of a major cerebral artery in the distribution of the internal carotid artery (evidence level 1a, recommendation grade A). Roughly 4-10% of all stroke patients could benefit from such an intervention. In the trials, 85% of the patients were first treated with IV-tPA. A recanalization of the occluded vessel was achieved by MT in 59-88% of patients. The percentage of patients with no deficit or only a mild deficit was 33-71% among those who received the intervention, compared to 19-40% in the control groups. The trial data indicate that MT is effective for elderly patients as well (age over 80). Thrombectomy did not increase the rate of secondary, symptomatic intracranial hemorrhage.CONCLUSION: MT can only be used to treat the occlusion of major cerebral arteries. In appropriate patients, it expands the spectrum of treatment options for stroke. Long-term data are not yet available.

AB - BACKGROUND: The introduction of neurological stroke units and of thrombolysis with the intravenous (IV) administration of recombinant tissue-type plasminogen activator (tPA) have markedly improved the treatment of stroke. Five randomized trials of catheter-based interventional treatment of stroke with special stents were published in 2015.METHODS: Recently published randomized trials of mechanical thrombectomy are selectively reviewed.RESULTS: These trials documented the clinical efficacy of mechanical thrombectomy (MT) in the treatment of occlusion of a major cerebral artery in the distribution of the internal carotid artery (evidence level 1a, recommendation grade A). Roughly 4-10% of all stroke patients could benefit from such an intervention. In the trials, 85% of the patients were first treated with IV-tPA. A recanalization of the occluded vessel was achieved by MT in 59-88% of patients. The percentage of patients with no deficit or only a mild deficit was 33-71% among those who received the intervention, compared to 19-40% in the control groups. The trial data indicate that MT is effective for elderly patients as well (age over 80). Thrombectomy did not increase the rate of secondary, symptomatic intracranial hemorrhage.CONCLUSION: MT can only be used to treat the occlusion of major cerebral arteries. In appropriate patients, it expands the spectrum of treatment options for stroke. Long-term data are not yet available.

U2 - 10.3238/arztebl.2015.0830

DO - 10.3238/arztebl.2015.0830

M3 - SCORING: Journal article

C2 - 26754120

VL - 112

SP - 830

EP - 836

JO - DTSCH ARZTEBL INT

JF - DTSCH ARZTEBL INT

SN - 1866-0452

IS - 49

ER -