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October 2015

Endovascular Therapy for Acute Ischemic Stroke: Dawn of a New Era

Author Affiliations
  • 1Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas
JAMA Neurol. 2015;72(10):1101-1103. doi:10.1001/jamaneurol.2015.1743

Patients with an occlusion of the distal internal carotid or proximal middle cerebral artery have among the most severe types of ischemic stroke that typically produce life-altering disabilities. Prior to a few months ago, the standard of care for such patients included intravenous (IV) alteplase and comprehensive peristroke care to avoid complications, including measures to prevent another stroke and comprehensive rehabilitation.

In December 2014, Berkhemer and colleagues1 published the results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study, which investigated the safety and efficacy of endovascular therapy for patients with large-vessel acute ischemic stroke. To our knowledge, this was the first large prospective randomized clinical trial to prove conclusively that endovascular therapy is safe and effective for treating these patients. Following the publication of MR CLEAN, the results of 3 additional studies (Extending the Time for Thrombolysis in Emergency Neurological Deficits With Intra-arterial Therapy [EXTEND-IA], Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing Computed Tomography to Recanalization Times [ESCAPE], and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment [SWIFT PRIME]) were presented at the International Stroke conference in Nashville, Tennessee, on February 11, 2015.2-4 As each presenter showed the key results, the audience spontaneously applauded. At the end of these presentations, one speaker simply said, “This now defines a new standard of care for patients with large-vessel strokes.” A fifth study, Randomized Trial of Revascularization With Solitaire FR Device vs Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within 8 Hours of Symptom Onset (REVASCAT), was recently published, showing similar results in a population from a region of Spain.5

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