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SUMMARY: Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention. ABBREVIATIONS: MR CLEAN Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands EMS Emergency Medical Services ESCAPE Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke EXTEND-IA Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-Arterial REVASCAT Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours SWIFT-PRIME Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: Jun 1, 2016
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