Consensus and suggestions for treatment algorithm - mechanical thrombectomy in acute cerebral infarction. The results of intervention studies MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA, REVASCAT
Abstract
For the first time in cerebrovascular neurologythere is an indisputable evidence of clinical effectiveness of mechanical recanalization in acute cerebral artery occlusion. Five randomized trials published in 2015 documented an unprecedented benefit and safety of endovascular thrombectomy.
The particular trials were: MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA and REVASCAT. It has been proven that endovascular treatment reduces morbidity and mortality of patients significantly.
The number needed to treat to result in one patient with good functional outcome was staggeringly low-only 3-7 patients. Age and deficit severity do not constitute exclusionary criteria (MR CLEAN, ESCAPE and EXTEND-IA without age restrictions; SWIFT PRIME between 18-80 years and REVASCAT between 18-85 years of age).
The principal imaging methods were predominantly native CT and CT angiography. Perfusion methods were used in EXTEND-IA and SWIFT PRIME.
The objective of endovascular treatment was to achieve reperfusion within 60 min after groin puncture. An essential part of the trials was a performance evaluation system.
We provide information on the results of thrombectomy trials, summarize management during thrombectomy (correction of blood pressure, use of anesthesia, concomitant medication) and propose indication criteria.