Decision-making strategies for reperfusion therapies: navigating through stroke trials gaps

ABSTRACT

Despite there being a robust amount of literature and numerous randomized clinical trials regarding acute ischemic stroke treatment, the trials have not included some frequent controversial situations for which decision-making strategies are an urgent and unmet need in clinical practice. This article tries to summarize the current evidence about some selected situations (mechanical thrombectomy in low ASPECTS, low NIHSS with proximal occlusion, acute basilar occlusion, distal and medium vessel occlusion, among others), make suggestions on how to approach them in clinical practice and show what to expect in acute stroke research in the near future.

RESUMO

Apesar de possuir um corpo de literatura robusto e inúmeros ensaios clínicos randomizados sobre o tratamento do AVC isquêmico agudo, os trials não incluíram algumas situações frequentes e controversas para as quais as estratégias de tomada de decisão são uma necessidade urgente na prática clínica. Este artigo tenta resumir as evidências atuais sobre algumas situações selecionadas (trombectomia mecânica em ASPECTS baixo, NIHSS baixo com oclusão proximal, oclusão basilar aguda, oclusão de vaso distal e médio, entre outras), propor sugestões de como abordá-las na prática clínica e mostrar o que esperar na pesquisa de AVC agudo no futuro próximo.

Keywords:

Stroke - Ischemic Stroke - Thrombectomy - Mechanical Thrombolysis - Thrombolytic Therapy

Palavras-chave:

Acidente Vascular Cerebral - AVC Isquêmico - Trombectomia - Trombólise Mecânica - Terapia Trombolítica

Authors’ contributions:

MPP: contributed to the conception, design, writing of all parts of the manuscript and review; INP, FBG: contributed to the writing of part of the manuscript and review the final manuscript.

Publication History

Received: 15 March 2022

Accepted: 29 April 2022

Article published online:
06 February 2023

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