PDF herunterladen
CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(12): 1030-1039
DOI: 10.1055/s-0043-1777721
View and Review

Reperfusion therapy for acute ischemic stroke: where are we in 2023?

Terapia de reperfusão para o acidente vascular isquêmico agudo: onde estamos em 2023?
Sheila Cristina Ouriques Martins 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
2   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Octávio Marques Pontes-Neto 
3   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
,
Arthur Pille 
1   Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.
2   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Thaís Leite Secchi 
2   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Maramélia Araújo de Miranda Alves 
4   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Letícia Costa Rebello 
5   Hospital de Base de Brasília, Brasília DF, Brazil.
,
Jamary Oliveira-Filho 
6   Universidade Federal da Bahia, Salvador BA, Brazil.
,
Marcos Christiano Lange 
7   Universidade Federal do Paraná, Hospital de Clínicas, Curitiba PR, Brazil.
,
Gabriel R. de Freitas 
8   Hospital Quinta D'Or, Rio de Janeiro RJ, Brazil.
,
João Brainer Clares de Andrade 
4   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
,
Letícia Januzi de Almeida Rocha 
9   Hospital Universitário Professor Alberto Antunes, Maceió AL, Brazil.
,
Daniel da Cruz Bezerra 
10   Hospital Pró-Cardíaco, Rio de Janeiro RJ, Brazil.
,
Ana Claudia de Souza 
2   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Leonardo Augusto Carbonera 
2   Hospital Moinhos de Vento, Porto Alegre RS, Brazil.
,
Raul Gomes Nogueira 
11   University of Pittsburgh, Pittsburgh PA, United States.
,
Gisele Sampaio Silva 
4   Universidade Federal de São Paulo, Hospital São Paulo, São Paulo SP, Brazil.
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

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.

Keywords

Stroke - Ischemic Stroke - Reperfusion - Thrombolytic Therapy - Thrombectomy

Palavras-chave

Acidente Vascular Cerebral - Acidente Vascular Cerebral Agudo - Reperfusão - Terapia Trombolítica - Trombectomia

Authors' 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.




Publikationsverlauf

Eingereicht: 06. November 2023

Angenommen: 21. November 2023

Artikel online veröffentlicht:
29. Dezember 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.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Fischer U, Arnold M, Nedeltchev K. et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke 2005; 36 (10) 2121-2125
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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 DOI: 10.1177/17474930211055932.
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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. DOI: 10.1016/S0140-6736(23)02032-9.
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar