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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(12): 1030-1039
DOI: 10.1055/s-0043-1777721
DOI: 10.1055/s-0043-1777721
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Reperfusion therapy for acute ischemic stroke: where are we in 2023?
Terapia de reperfusão para o acidente vascular isquêmico agudo: onde estamos em 2023?Authors
Abstract
Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.
Resumo
Nas últimas três décadas, o tratamento do AVC sofreu transformações significativas, impulsionadas principalmente pela introdução das terapias de reperfusão e pela organização dos serviços de AVC. Os pacientes que recebem tratamento em um serviço de AVC bem estruturado têm uma probabilidade muito maior de resultados favoráveis, diminuindo assim a incapacidade funcional e a mortalidade. Neste artigo, revisamos as evidências científicas para as terapias de reperfusão do AVC, incluindo trombólise e trombectomia e sua implementação no sistema público de saúde no Brasil.
Palavras-chave
Acidente Vascular Cerebral - Acidente Vascular Cerebral Agudo - Reperfusão - Terapia Trombolítica - TrombectomiaAuthors' Contributions
SM: conceptualization, data curation, methodology, project administration, writing – original draft, writing – review & editing; AP: investigation, writing – review & editing; TLS: writing – review & editing; OMPN, MAMA, GSS: data curation, validation, writing – review & editing; LCR, JOF, MCL, GRF, JBCA, LJAR, DCB, ACS, LAC, RGN: validation.
Publication History
Received: 06 November 2023
Accepted: 21 November 2023
Article published online:
29 December 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
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References
- 1 Feigin VL, Stark BA, Johnson CO. et al; GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20 (10) 795-820
- 2 Martins SC, Pontes-Neto OM, Alves CV. et al. Past, present and future of stroke in middle income countries:The Brazilian experience. International Stroke Journal. 2013, Volume 8, Supp A 100: 106–111. Stroke 2015; 46 (10) 3020-3035
- 3 Ministry of Health of Brazil. DATASUS–Mortality Information System. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10uf.def . Assessed in December 01, 2022
- 4 Ganesh A, Lindsay P, Fang J. et al. Integrated systems of stroke care and reduction in 30-day mortality: A retrospective analysis. Neurology 2016; 86 (10) 898-904
- 5 Powers WJ, Rabinstein AA, Ackerson T. et al. 2019 Update to the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association. Stroke 2019; 50: E344-E418
- 6 Martins SCO, Freitas GR, Pontes-Neto OM. et al; Executive Committee from the Brazilian Stroke Society and the Scientific Department in Cerebrovascular Diseases of the Brazilian Academy of Neurology. Guidelines for acute ischemic stroke treatment: part II: stroke treatment. Arq Neuropsiquiatr 2012; 70 (11) 885-893
- 7 Pontes-Neto OM, Cougo P, Martins SCO. et al. Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke. Arq Neuropsiquiatr 2017; 75 (01) 50-56
- 8 Clinical Protocol and Therapeutic Guidelines Thrombolysis in acute ischemic stroke. Ordinance GM/MS No. 664, of April 12, 2012 . Accessed December 1, 2022. Available at: http://conitec.gov.br/images/Protocolos/Tromb–lise-no-Acidente-Vascular-Cerebral-Isqu–mico-Agudo.pdf
- 9 Ministry of Health. Ordinance 665. Stroke [Internet]. Brasilia; 2012 . Accessed December 1, 2022. Available in: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2012/PRT0665_12_04_2012.html
- 10 Ministry of Health. Ordinance 800. Stroke [Internet]. Brasilia; 2012 . Accessed December 1, 2022. Available at: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2015/prt0800_17_06_2015.html
- 11 https://www.in.gov.br/en/web/dou/-/portaria-sctie/ms-n-5-de-19-de-fevereiro-de-2021-304456104 . Accessed December 1, 2022
- 12 The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581-1587 PubMed
- 13 The ATLANTIS, ECASS, and NINDS rt-PA study group investigators. Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363: 768-774 PubMed
- 14 Berkhemer OA, Fransen PS, Beumer D. et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
- 15 Goyal M, Demchuk AM, Menon BK. et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
- 16 Saver JL, Goyal M, Bonafe A. et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
- 17 Campbell BC, Mitchell PJ, Kleinig TJ. et al; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372 (11) 1009-1018
- 18 Jovin TG, Chamorro A, Cobo E. et al; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24) 2296-2306
- 19 Nogueira RG, Jadhav AP, Haussen DC. et al; DAWN Trial Investigators. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378 (01) 11-21
- 20 Albers GW, Marks MP, Kemp S. et al; DEFUSE 3 Investigators. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018; 378 (08) 708-718
- 21 The National Institute of Neurological Disorders and Stroke rt-pa stroke study group (NINDS). Generalized efficacy of t-pa for acute stroke. Subgroup analysis of the ninds t-pa stroke trial. Stroke 1997; 28: 2119-2125 PubMed
- 22 Hacke W, Kaste M, Bluhmki E. et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359 (13) 1317-1329
- 23 IST-3 collaborative group. Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G. et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomized controlled trial. Lancet 2012; 379: 2352-63 PubMed
- 24 Wardlaw JM, Murray V, Berge E. et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379 (9834) 2364-2372
- 25 Anderson CS, Robinson T, Lindley RI. et al; ENCHANTED Investigators and Coordinators. Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke. N Engl J Med 2016; 374 (24) 2313-2323
- 26 Ma H, Campbell BCV, Parsons MW. et al; EXTEND Investigators. Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med 2019; 380 (19) 1795-1803 . Erratum in: N Engl J Med. 2021 Apr 1;384(13):1278
- 27 Thomalla G, Simonsen CZ, Boutitie F. et al; WAKE-UP Investigators. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med 2018; 379 (07) 611-622
- 28 Hacke W, Kaste M, Fieschi C. et al; The European Cooperative Acute Stroke Study (ECASS). Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 1995; 274 (13) 1017-1025
- 29 Tanne D, Kasner SE, Demchuk AM. et al. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 2002; 105 (14) 1679-1685
- 30 The National Institute of Neurological Disorders and Stroke rt-pa stroke study group. Intracerebral hemorrhage after intravenous t-pa therapy for ischemic stroke. Stroke 1997; 28: 2109-2118
- 31 Bhatia R, Hill MD, Shobha N. et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 2010; 41 (10) 2254-2258
- 32 Fischer U, Arnold M, Nedeltchev K. et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke 2005; 36 (10) 2121-2125
- 33 Ciccone A, Valvassori L, Nichelatti M. et al; SYNTHESIS Expansion Investigators. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368 (10) 904-913
- 34 Broderick JP, Palesch YY, Demchuk AM. et al; Interventional Management of Stroke (IMS) III Investigators. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368 (10) 893-903
- 35 Kidwell CS, Jahan R, Gornbein J. et al; MR RESCUE Investigators. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368 (10) 914-923
- 36 Goyal M, Menon BK, van Zwam WH. et al; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387 (10029): 1723-1731
- 37 Saver JL, Goyal M, van der Lugt A. et al; HERMES Collaborators. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016; 316 (12) 1279-1288
- 38 Martins SO, Mont'Alverne F, Rebello LC. et al; RESILIENT Investigators. Thrombectomy for Stroke in the Public Health Care System of Brazil. N Engl J Med 2020; 382 (24) 2316-2326
- 39 de Souza AC, Martins SO, Polanczyk CA. et al. Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial. Int J Stroke 2021; 17474930211055932: 17 474930211055932; Epub ahead of print
- 40 Nogueira RG, Haussen DC, Liebeskind D. et al; Trevo Registry and DAWN Trial Investigators. Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows. Stroke 2021; 52 (02) 491-497
- 41 Bendszus M, Fiehler J, Subtil F. et al; TENSION Investigators. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402 (10414): 1753-1763 :S0140-6736(23)02032-9.
- 42 Langezaal LCM, van der Hoeven EJRJ, Mont'Alverne FJA. et al; BASICS Study Group. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med 2021; 384 (20) 1910-1920
- 43 Liu X, Dai Q, Ye R. et al; BEST Trial Investigators. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 2020; 19 (02) 115-122
- 44 Jovin TG, Li C, Wu L. et al; BAOCHE Investigators. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med 2022; 387 (15) 1373-1384
- 45 Tao C, Nogueira RG, Zhu Y. et al; ATTENTION Investigators. Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med 2022; 387 (15) 1361-1372
- 46 Fiehler J, Cognard C, Gallitelli M. et al. European recommendations on organisation of interventional care in acute stroke (EROICAS). Int J Stroke 2016; 11 (06) 701-716
- 47 Seners P, Turc G, Maïer B, Mas JL, Oppenheim C, Baron JC. Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke 2016; 47 (09) 2409-2412
- 48 Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke 2011; 42 (06) 1775-1777
- 49 Tsivgoulis G, Zand R, Katsanos AH. et al. Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis. JAMA Neurol 2016; 73 (06) 675-683
- 50 Kaesmacher J, Maegerlein C, Kaesmacher M. et al. Thrombus migration in the middle cerebral artery: incidence, imaging signs, and impact on success of endovascular thrombectomy. J Am Heart Assoc 2017; 6 (02) E005149
- 51 Majoie CB, Cavalcante F, Gralla J. et al; IRIS collaborators. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet 2023; 402 (10406): 965-974
- 52 Martins SCO, Weiss G, Almeida AG. et al. Validation of a smartphone application in the evaluation and treatment of acute stroke in a comprehensive stroke center. Stroke 2020; 51 (01) 240-246