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Acute therapy of stroke and reperfusion treatments
Published on April 27, 2021 35 min
A selection of talks on Neuroscience
Roles of microglia in the healthy brain
- Dr. Marie-Ève Tremblay
- University of Victoria, Canada
Bioelectronic medicine: immunomodulation by vagus nerve stimulation
- Prof. Paul Peter Tak
- Amsterdam University Medical Centre, The Netherlands
My name is Brian Silver. I'm from the Department of Neurology at the University of Massachusetts Medical School in Worcester, Massachusetts, United States. I'll be talking on acute therapy of stroke and reperfusion treatments. Particularly changes that have occurred over the last decade.
In terms of the overview, I'll be reviewing the reperfusion therapies including tPA and mechanical thrombectomy. I'll then describe individual differences in ischemic stroke progression. Finally, I'll discuss some future directions on how therapies can improve.
So in terms of the timeline on how reperfusion therapies have evolved since 1995, the first positive trial occurred in 1995, showing that tPA was effective for the treatment of ischemic stroke up to three hours. Then it took 13 years to show that the same treatment was effective up to 4.5 hours. Then it was not for another seven years in 2015 before thrombectomy, which is where a device is inserted into the clot in order to remove it from the blood vessel, was shown to be effective up until six hours. Then right after that, very rapidly, we saw a number of studies showing the benefit of thrombectomy and tPA using advanced imaging or artificial intelligence, if you will, to benefit patients in an extended time window. In 2018, there were positive thrombectomy trials up to 24 hours. Then there was a tPA trial beyond 4.5 hours with an MRI mismatch. And there was a positive tPA trial between 4.5 and 9 hours using CT perfusion, and a mismatch on that sequence, showing benefit as well. What is not shown on this slide are the series of negative trials that informed the development of these positive trials and lessons learned. So this is a brief timeline of how the evolution of tPA and thrombectomy have occurred since 1995. So, tPA is established, up to 4.5 hours currently, with plain CT scan of the head.