Search Results for: Endovascular

To Lyse Before Endovascular Intervention … or Not

I’ve been of the general opinion that, no, thrombolytics are of low utility prior to endovascular intervention for stroke. The typical candidate for endovascular intervention has a clot in a large vessel. Thrombolytics are overwhelmingly ineffective at treating such lesions, hence, the entire foundational need for endovascular intervention. Then, absent indication creep, the patients for … Continue reading “To Lyse Before Endovascular Intervention … or Not”

Take Large-Vessel Strokes Directly to Endovascular Centers

This isn’t exactly “news” – or it shouldn’t be – because the basic underlying hypotheses for care in cerebral ischemia are: 1) identify or assume viable brain tissue, and 2) effectively reperfuse said tissue. So, of course, delays in 2 will lead to reductions in remaining viable 1 – the so-called “time is brain”. This … Continue reading “Take Large-Vessel Strokes Directly to Endovascular Centers”

Correct, Endovascular Therapy Does Not Benefit All Patients

Unfortunately, that headline is the strongest takeaway available from these data. Currently, endovascular therapy for stroke is recommended for all patients with a proximal arterial occlusion and can be treated within six hours. The much-ballyhooed “number needed to treat” for benefit is approximately five, and we have authors generating nonsensical literature with titles such as … Continue reading “Correct, Endovascular Therapy Does Not Benefit All Patients”

Some Old News About Thrombolysis Before Endovascular Therapy

We’ve spent a little bit of energy on this blog teasing out the appropriate indications for endovascular therapy, and and we’ve used a few of those words to discuss whether thrombolysis prior to is necessary. I am of the opinion: probably not. It turns out, there are many other prominent neurologists who share that same … Continue reading “Some Old News About Thrombolysis Before Endovascular Therapy”

Endovascular Therapy for Large Ischemic Cores

The vast majority of the important evidence regarding the use of endovascular therapy for stroke has substantial limitations. The critical studies, with the largest magnitude of benefit, used strict imaging criteria to limit interventions to large-vessel occlusions with only small-volume ischemic cores surrounded by large regions of surviving tissue. Further generalizing these data to the … Continue reading “Endovascular Therapy for Large Ischemic Cores”

Endovascular for Stroke – Even Better than the Evidence

What happens when you let Medtronic, et al, author an article on endovascular therapy in The Lancet:  exactly what you’d expect. We are, in principle, fans of endovascular therapy for acute stroke as presented in the major trials: ESCAPE, EXTEND-IA, and SWIFT-PRIME.  These trials carefully selected eligible patients by use of advanced perfusion imaging and … Continue reading “Endovascular for Stroke – Even Better than the Evidence”

Endovascular Sans tPA in Bern

The first hints of a rollback in tPA use are starting to emerge – not unexpectedly, from those working to improve the outcomes of their endovascular programs. This is a retrospective evaluation of patients from Bern, Switzerland, all treated with endovascular therapy.  Their registry includes 372 patients since 2004, all treated for MCA or ICA … Continue reading “Endovascular Sans tPA in Bern”

New AHA/ASA Endovascular Guidelines

How did I find out about the final publication of the new AHA/ASA Guidelines regarding endovascular intervention in acute ischemic stroke?  I received unsolicited e-mail spam from their representative at a public relations firm, gushing about the technology and offering to put me in touch with their generously available expert. Before getting into the content, … Continue reading “New AHA/ASA Endovascular Guidelines”

Christmas Comes Early for Endovascular Therapy in Stroke

Quite literally, in fact, considering the timing of the publication of MR-CLEAN – and, now, the triple fall-out from those results. Due to the positive findings presented by the MR-CLEAN investigators in December 2014, three other ongoing major endovascular trials used this opportunity to check their results early.  ESCAPE, EXTEND-IA, and SWIFT-PRIME – all products … Continue reading “Christmas Comes Early for Endovascular Therapy in Stroke”

Endovascular Therapy, Unproven Efficacy, Unproven Effectiveness

With the publication of MR-CLEAN two days ago, the medical world (especially Covidien, Stryker, and Penumbra) is ready to throw out all previous neutral trials – MR-RESCUE, SYNTHESIS, IMS-3 – and rush headlong into endovascular therapy for acute ischemic stroke as a new standard of care. Nonsense, you say?  Not when financial and professional conflicts-of-interest … Continue reading “Endovascular Therapy, Unproven Efficacy, Unproven Effectiveness”