Despite probable higher rates of recanalization with endovascular therapies, limited evidence exists to support the clinical benefits in patients with stroke who are unresponsive to standard intravenous reperfusion. A new study supports combined intravenous-intra-arterial treatment in a subset of acute stroke patients, and recognizes the need for definitive randomized trials.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N. Engl. J. Med. 333, 1581–1587 (1995).
Rymer, M. M. et al. Interventional acute stroke therapy with the Merci retriever embolectomy device: results from 1000 patients in an open label prospective multicenter registry [late-breaking abstract 5]. Presented at the 2011 International Stroke Conference. American Heart Association [online], (2011).
Khatri, P. et al. for the Interventional Management of Stroke III Investigators. Methodology of the Interventional Management of Stroke III Trial. Int. J. Stroke 3, 130–137 (2008).
Rubiera, M. et al. Bridging intravenous-intra-arterial rescue strategy increases recanalization and the likelihood of a good outcome in nonresponder intravenous tissue plasminogen activator-treated patients: a case–control study. Stroke 42, 993–997 (2011).
NIH–National Institute of Neurological Disorders and Stroke (NINDS). Clinical alert—angioplasty combined with stenting plus aggressive medical therapy vs. aggressive medical therapy alone for intracranial arterial stenosis: NINDS stops trial enrollment due to a higher risk of stroke and death in the stented group. American Academy of Neurology [online], (2011).
Khatri, P. et al. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 73, 1066–1072 (2009).
Mishra, N. K. et al. Mismatch-based delayed thrombolysis: a meta-analysis. Stroke 41, e25–e33 (2010).
Nichols, C. et al. Is peri-procedural sedation during acute stroke therapy associated with poorer functional outcomes? J. Neurointerv. Surg. 2, 67–70 (2010).
Rha, J. H. & Saver, J. L. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38, 967–973 (2007).
Acknowledgements
The author's work is supported by the NIH-National Institute of Neurological Disorders and Stroke, grant number K23NS059843.
Author information
Authors and Affiliations
Ethics declarations
Competing interests
P. Khatri receives grant/research support from Genentech.
Rights and permissions
About this article
Cite this article
Khatri, P. Intra-arterial stroke therapy looks promising, but for whom?. Nat Rev Neurol 7, 427–428 (2011). https://doi.org/10.1038/nrneurol.2011.109
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneurol.2011.109
