eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 10

New perspectives for acute stroke treatment: the role of mechanical thrombectomy

Agnieszka Slowik

Postep Kardiol Inter 2014; 10, 3 (37): 145–146
Online publish date: 2014/09/11
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Stroke is the third leading cause of death and a major cause of disability in adults. In Poland, up to 80,000 people suffer from stroke each year; 25% die within 90 days, and those who survive need support in everyday life.
Acute stroke treatment with IV rt-PA, routinely available since the 1990s, can be utilised in only a small percentage of stroke victims. IV rt-PA gives a 30% increase in the number of patients who recover completely. The low percentage of patients who can be treated with IV rt-PA is due to its narrow therapeutic window (4.5 h). During that timeframe, not only must a detailed interview be conducted and a neurological examination be performed, but also brain neuroimaging and several blood tests must be obtained. To complete all of these procedures in such a short timeframe requires perfect organisation and the close collaboration of all parties involved in the treatment process. In Poland, treatment with IV rt-PA is performed in stroke units that are typically divisions of neurology departments.
In the last few years, leading European and American stroke centres have introduced endovascular treatment – mechanical thrombectomy and, to a much lesser extent, pharmacological treatment by intra-arterial (IA) rt-PA. Pharmacological IA treatment can only be performed following consultation with an ethics committee, since the efficacy of these interventional treatments has not been confirmed in large clinical trials. It should be noted that mechanical thrombectomy can be used up to 8 h following onset of symptoms for strokes located in the anterior circulation, and in some specific cases even up to 24 h later. This wider treatment window allows us to employ this interventional treatment for many more victims of acute stroke. Information concerning the current indication for endovascular treatment of acute stroke is available in European (European Stroke Organisation) and American (American Heart Association/American Stroke Association) guidelines.
The first device for mechanical thrombectomy in acute stroke, MERCI (Concentric Medical), was approved by the FDA in the US 10 years ago. The second device, Penumbra (Penumbra, Alameda, CA, USA), was approved several years later. Although both devices increased significantly the percentage of brain vessels that were re-canalised, the percentage of patients who recovered completely was still less than 25%.
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