Thrombolytic versus endovascular management in ischemic stroke
Keywords:
Stroke, Thrombectomy, Thrombolytic TherapyAbstract
Introduction: ischemic stroke is an endemic pathology, of which its approach has been studied since new techniques and technologies have been developed in its treatment. Currently, there are two types of therapies, thrombolysis, and thrombectomy.
Objective: the objective of this review is to describe ischemic stroke and compare both therapeutic approaches, their benefits, and limitations in the management of the disease.
Method: the design of the review was evaluative and the search for articles was carried out in the PubMed, Cochrane, and SciELO databases, with the following selection criteria: systemic reviews, meta-analysis, clinical and preclinical trials, guidelines for clinical practice, and bibliographic reviews published from 2015 to 2020, with a total of 32 articles and 4 books consulted with adequate quality and validity.
Development: mechanical thrombectomy has generated good functional results, with better recanalization rates and a longer therapeutic window than thrombolysis, with direct aspiration being cost-effective and with better results than the application of the stentriever.
Conclusions: the primary management of acute ischemic stroke with mechanical thrombectomy by direct aspiration is cost-effective, with better functional results than thrombolysis alone, and is effective with or without it.
References
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Guzik A, Bushnell C. Stroke epidemiology and risk factor management. Continuum (Minneap Minn) [Internet]. 2017 [citado 10 Ago 2020];23(1, Cerebrovascular Disease):15-39. Disponible en: https://doi.org/10.1212/CON.0000000000000416
Radu RA, Terecoasa EO, Bajenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand? Clin Neurol Neurosurg [Internet]. 2017 [citado 10 Ago 2020];159: 93-106. Disponible en: https://doi.org/10.1016/j.clineuro.2017.05.019
George P, Steinberg G. Novel stroke therapeutics: unraveling stroke pathophysiology and its impact on clinical treatments. Neuron [Internet]. 2015 Jul [citado 10 Ago 2020];87(2): 297–309. Disponible en: https://doi.org/10.1016/j.neuron.2015.05.041
Norris T, Lalchandani, R. Porth’s Pathophysiology. 10va ed. Philadelphia: Wolters Kluwer; 2019.
Splittgerber R. Snell. Neuroanatomía clínica. 8va ed. Philadelphia: Wolters Kluwer; 2019.
Baynes J, Dominiczak M. Bioquímica médica. 5ta ed. Barcelona: Elsevier; 2019.
Koh S, Park H. Neurogenesis in stroke recovery. Transl. Stroke Res [Internet]. 2016 [citado 10 Ago 2020];8:3-13. Disponible en: https://doi.org/10.1007/s12975-016-0460-z
Yang C, Hawkins KE, Doré S, Candelario-Jalil E. Neuroinflammatory mechanisms of blood-brain barrier damage in ischemic stroke. Am J Physiol Cell Physiol [Internet]. 2019 [citado 10 Ago 2020];316(2):C135-C153. Disponible en: https://doi.org/10.1152/ajpcell.00136.2018
Kurisu K, Yenari MA. Therapeutic hypothermia for ischemic stroke; pathophysiology and future promise. Neuropharmacology [Internet]. 2018 [citado 10 Ago 2020];134(Pt B):302-9. Disponible en: https://doi.org/10.1016/j.neuropharm.2017.08.025
Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke [Internet]. 2019 [citado 10 Ago 2020];50(12):e355-e380. Disponible en: https://doi.org/10.1161/STR.0000000000000211
Campbell BC. Thrombolysis and thrombectomy for acute ischemic stroke: strengths and synergies. Semin Thromb Hemost [Internet]. 2017 [citado 10 Ago 2020];43(2):185-90. Disponible en: https://doi.org/10.1055/s-0036-1585078
Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA [Internet]. 2015 [citado 10 Ago 2020];313(14):1451-62. Disponible en: https://doi.org/10.1001/jama.2015.3058
Martins SO, Mont'Alverne F, Rebello LC, Abud DG, Silva GS, Lima FO, et al. Thrombectomy for Stroke in the Public Health Care System of Brazil. N Engl J Med [Internet]. 2020 [citado 11 Nov 2020];382(24):2316-2326. Disponible en: https://doi.org/10.1056/NEJMoa2000120
Mordasini P, Gralla J. Developments in mechanical thrombectomy devices for the treatment of acute ischemic stroke. Expert Rev Med Devices [Internet]. 2016 [citado 10 Ago 2020];13(1):71-81. Disponible en: https://doi.org/10.1586/17434440.2015.1124019
Pierot L, Gawlitza M, Soize S. Techniques for endovascular treatment of acute ischemic stroke. Rev Neurol (Paris) [Internet]. 2017 [citado 11 Ago 2020];173(9):594-9. Disponible en: https://doi.org/10.1016/j.neurol.2017.09.005
Asadi H, Dowling R, Yan B, Wong S, Mitchell P. Advances in endovascular treatment of acute ischaemic stroke. Intern Med J [Internet]. 2015 [citado 10 Ago 2020];45(8):798-805. Disponible en: https://doi.org/10.1111/imj.12652
Malhotra A, Boltyenkov A, Wu X, Matouk C, Forman H, Gandhi D, et al. Endovascular contact aspiration versus stent retriever for revascularization in patients with acute ischemic stroke and large vessel occlusion: a cost-minimization analysis. World Neurosurg [Internet]. 2020 [citado 10 Ago 2020];139:e23-e31. Disponible en: https://doi.org/10.1016/j.wneu.2020.02.078
Phan K, Maingard J, Kok HK, Dmytri A, Goyal S, Chandra R, et al. Contact aspiration versus stent-retriever thrombectomy for distal middle cerebral artery occlusions in acute ischemic stroke: meta-analysis. Neurointervention [Internet]. 2018 [citado 11 Ago 2020];13(2):100-9. Disponible en: https://doi.org/10.5469/neuroint.2018.00997
Primiani CT, Vicente AC, Brannick MT, Turk AS, Mocco J, Levy EI, et al. Direct aspiration versus stent retriever thrombectomy for acute stroke: a systematic review and meta-analysis in 9127 patients. J Stroke Cerebrovasc Dis [Internet]. 2019 [citado 10 Ago 2020];28(5):1329-37. Disponible en: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.034
Xing PF, Yang PF, Li ZF, Zhang L, Shen HJ, Zhang YX, et al. comparison of aspiration versus stent retriever thrombectomy as the preferred strategy for patients with acute terminal internal carotid artery occlusion: a propensity score matching analysis. AJNR Am J Neuroradiol [Internet]. 2020 [citado 10 Ago 2020];41(3):469-476. Disponible en: https://doi.org/10.3174/ajnr.A6414
Turk 3rd AS, Siddiqui A, Fifi JT, De Leacy Ra, Fiorella DJ, Gu E, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet [Internet]. 2019 [citado 10 Ago 2020];393(10175):998-1008. Disponible en: https://doi.org/10.1016/S0140-6736(19)30297-1
Zafar M, Mussa M, Memon RS, Nadeem S, Usman MS, Siddiqi J, et al. Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: a systematic review and meta-analysis. Cureus [Internet]. 2020 [citado 10 Ago 2020];12(5):e8380. Disponible en: https://doi.org/10.7759/cureus.8380
Bernstock JD, Peruzzotti-Jametti L, Ye D, Gessler FA, Maric D, Vicario N, et al. Neural stem cell transplantation in ischemic stroke: A role for preconditioning and cellular engineering. J Cereb Blood Flow Metab [Internet]. 2017 [citado 10 Ago 2020];37(7):2314-19. Disponible en: https://doi.org/10.1177/0271678X17700432
Venkat P, Shen Y, Chopp M, Chen J. Cell-based and pharmacological neurorestorative therapies for ischemic stroke. Neuropharmacology [Internet]. 2018 [citado 10 Ago 2020];134(Pt B):310-22. Disponible en: https://doi.org/10.1016/j.neuropharm.2017.08.036
Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, et al. MRI-Guided thrombolysis for stroke with unknown time of onset. N Engl J Med [Internet]. 2018 [citado 07 Nov 2020];379(7):611-622. Disponible en: https://doi.org/10.1056/NEJMoa1804355
Campbell BC, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus Alteplase before thrombectomy for ischemic stroke. N Engl J Med [Internet]. 2018 [citado 10 Nov 2020];378(17):1573-1582. Disponible en: https://doi.org/10.1056/NEJMoa1716405
Marmagkiolis K, Hakeem A, Cilingiroglu M, Gundogdu B, Iliescu C, Tsitlakidou D, et al. Safety and efficacy of stent retrievers for the management of acute ischemic stroke: comprehensive review and meta-analysis. JACC Cardiovasc Interv [Internet]. 2015 [citado 10 Nov 2020];8:1758–1765. Disponible en: https://doi.org/10.1016/j.jcin.2015.07.021
Bush CK, Kurimella D, Cross LJS, Conner KR, Martin-Schild S, He J, et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One [Internet]. 2016 [citado 10 Nov 2020];11(1):e0147287. Disponible en: https://doi.org/10.1371/journal.pone.0147287
Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical thrombectomy in acute ischemic stroke: A Systematic Review. Can J Neurol Sci [Internet]. 2016 [citado 10 Nov 2020];43(4):455-460. Disponible en: https://doi.org/10.1017/cjn.2016.30
Health Quality Ontario. Mechanical thrombectomy in patients with acute ischemic stroke: a health technology assessment. Ont Health Technol Assess Ser [Internet]. 2016 [citado 11 Nov 2020];16(4):179. Disponible en: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Journal-Ontario-Health-Technology-Assessment-Series/hta-mechanical-thrombectomy
Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, et. al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med [Internet]. 2020 [citado 11 Nov 2020];382(21):1981-1993. Disponible en: https://doi.org/10.1056/NEJMoa2001123
Achit H, Soudant M, Hosseini K, Bannay A, Epstein J, Bracard S, et al. Cost-Effectiveness of thrombectomy in patients with acute ischemic stroke: The THRACE Randomized Controlled Trial. Stroke [Internet]. 2017 [citado 11 Nov 2020];48(10):2843-2847. Disponible en: https://doi.org/10.1161/STROKEAHA.117.017856
Balami JS, Sutherland BA, Edmunds LD, Grunwald IQ, Neuhaus AA, Hadley G, et al. A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke. Int J Stroke [Internet]. 2015 [citado 11 Nov 2020];10(8):1168-1178. Disponible en: https://doi.org/10.1111/ijs.12618
García C, Martínez AE, García V, Ricaurte A, Torres I, Coral J. Actualización en diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo. Univ. Med. [Internet]. 2019 [citado 10 Ago 2020];60(3):1-13. Disponible en: https://doi.org/10.11144/Javeriana.umed60-3.actu
De la Garza-Longoria RS, Maldonado-Mancillas JA, Mendoza-Múzquiz PL, Sánchez L. Incidencia de enfermedad cerebrovascular en un servicio de Medicina Interna. Med Int Méx [Internet]. 2018 [citado 10 Ago 2020];34(6):874-80. Disponible en: https://doi.org/10.24245/mim.v34i6.2062
Guzik A, Bushnell C. Stroke epidemiology and risk factor management. Continuum (Minneap Minn) [Internet]. 2017 [citado 10 Ago 2020];23(1, Cerebrovascular Disease):15-39. Disponible en: https://doi.org/10.1212/CON.0000000000000416
Radu RA, Terecoasa EO, Bajenaru OA, Tiu C. Etiologic classification of ischemic stroke: Where do we stand? Clin Neurol Neurosurg [Internet]. 2017 [citado 10 Ago 2020];159: 93-106. Disponible en: https://doi.org/10.1016/j.clineuro.2017.05.019
George P, Steinberg G. Novel stroke therapeutics: unraveling stroke pathophysiology and its impact on clinical treatments. Neuron [Internet]. 2015 Jul [citado 10 Ago 2020];87(2): 297–309. Disponible en: https://doi.org/10.1016/j.neuron.2015.05.041
Norris T, Lalchandani, R. Porth’s Pathophysiology. 10va ed. Philadelphia: Wolters Kluwer; 2019.
Splittgerber R. Snell. Neuroanatomía clínica. 8va ed. Philadelphia: Wolters Kluwer; 2019.
Baynes J, Dominiczak M. Bioquímica médica. 5ta ed. Barcelona: Elsevier; 2019.
Koh S, Park H. Neurogenesis in stroke recovery. Transl. Stroke Res [Internet]. 2016 [citado 10 Ago 2020];8:3-13. Disponible en: https://doi.org/10.1007/s12975-016-0460-z
Yang C, Hawkins KE, Doré S, Candelario-Jalil E. Neuroinflammatory mechanisms of blood-brain barrier damage in ischemic stroke. Am J Physiol Cell Physiol [Internet]. 2019 [citado 10 Ago 2020];316(2):C135-C153. Disponible en: https://doi.org/10.1152/ajpcell.00136.2018
Kurisu K, Yenari MA. Therapeutic hypothermia for ischemic stroke; pathophysiology and future promise. Neuropharmacology [Internet]. 2018 [citado 10 Ago 2020];134(Pt B):302-9. Disponible en: https://doi.org/10.1016/j.neuropharm.2017.08.025
Powers W, Rabinstein A, Ackerson T, Adeoye O, Bambakidis N, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke [Internet]. 2019 [citado 10 Ago 2020];50(12):e355-e380. Disponible en: https://doi.org/10.1161/STR.0000000000000211
Campbell BC. Thrombolysis and thrombectomy for acute ischemic stroke: strengths and synergies. Semin Thromb Hemost [Internet]. 2017 [citado 10 Ago 2020];43(2):185-90. Disponible en: https://doi.org/10.1055/s-0036-1585078
Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA [Internet]. 2015 [citado 10 Ago 2020];313(14):1451-62. Disponible en: https://doi.org/10.1001/jama.2015.3058
Martins SO, Mont'Alverne F, Rebello LC, Abud DG, Silva GS, Lima FO, et al. Thrombectomy for Stroke in the Public Health Care System of Brazil. N Engl J Med [Internet]. 2020 [citado 11 Nov 2020];382(24):2316-2326. Disponible en: https://doi.org/10.1056/NEJMoa2000120
Mordasini P, Gralla J. Developments in mechanical thrombectomy devices for the treatment of acute ischemic stroke. Expert Rev Med Devices [Internet]. 2016 [citado 10 Ago 2020];13(1):71-81. Disponible en: https://doi.org/10.1586/17434440.2015.1124019
Pierot L, Gawlitza M, Soize S. Techniques for endovascular treatment of acute ischemic stroke. Rev Neurol (Paris) [Internet]. 2017 [citado 11 Ago 2020];173(9):594-9. Disponible en: https://doi.org/10.1016/j.neurol.2017.09.005
Asadi H, Dowling R, Yan B, Wong S, Mitchell P. Advances in endovascular treatment of acute ischaemic stroke. Intern Med J [Internet]. 2015 [citado 10 Ago 2020];45(8):798-805. Disponible en: https://doi.org/10.1111/imj.12652
Malhotra A, Boltyenkov A, Wu X, Matouk C, Forman H, Gandhi D, et al. Endovascular contact aspiration versus stent retriever for revascularization in patients with acute ischemic stroke and large vessel occlusion: a cost-minimization analysis. World Neurosurg [Internet]. 2020 [citado 10 Ago 2020];139:e23-e31. Disponible en: https://doi.org/10.1016/j.wneu.2020.02.078
Phan K, Maingard J, Kok HK, Dmytri A, Goyal S, Chandra R, et al. Contact aspiration versus stent-retriever thrombectomy for distal middle cerebral artery occlusions in acute ischemic stroke: meta-analysis. Neurointervention [Internet]. 2018 [citado 11 Ago 2020];13(2):100-9. Disponible en: https://doi.org/10.5469/neuroint.2018.00997
Primiani CT, Vicente AC, Brannick MT, Turk AS, Mocco J, Levy EI, et al. Direct aspiration versus stent retriever thrombectomy for acute stroke: a systematic review and meta-analysis in 9127 patients. J Stroke Cerebrovasc Dis [Internet]. 2019 [citado 10 Ago 2020];28(5):1329-37. Disponible en: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.034
Xing PF, Yang PF, Li ZF, Zhang L, Shen HJ, Zhang YX, et al. comparison of aspiration versus stent retriever thrombectomy as the preferred strategy for patients with acute terminal internal carotid artery occlusion: a propensity score matching analysis. AJNR Am J Neuroradiol [Internet]. 2020 [citado 10 Ago 2020];41(3):469-476. Disponible en: https://doi.org/10.3174/ajnr.A6414
Turk 3rd AS, Siddiqui A, Fifi JT, De Leacy Ra, Fiorella DJ, Gu E, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet [Internet]. 2019 [citado 10 Ago 2020];393(10175):998-1008. Disponible en: https://doi.org/10.1016/S0140-6736(19)30297-1
Zafar M, Mussa M, Memon RS, Nadeem S, Usman MS, Siddiqi J, et al. Aspiration thrombectomy versus stent retriever thrombectomy alone for acute ischemic stroke: a systematic review and meta-analysis. Cureus [Internet]. 2020 [citado 10 Ago 2020];12(5):e8380. Disponible en: https://doi.org/10.7759/cureus.8380
Bernstock JD, Peruzzotti-Jametti L, Ye D, Gessler FA, Maric D, Vicario N, et al. Neural stem cell transplantation in ischemic stroke: A role for preconditioning and cellular engineering. J Cereb Blood Flow Metab [Internet]. 2017 [citado 10 Ago 2020];37(7):2314-19. Disponible en: https://doi.org/10.1177/0271678X17700432
Venkat P, Shen Y, Chopp M, Chen J. Cell-based and pharmacological neurorestorative therapies for ischemic stroke. Neuropharmacology [Internet]. 2018 [citado 10 Ago 2020];134(Pt B):310-22. Disponible en: https://doi.org/10.1016/j.neuropharm.2017.08.036
Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, et al. MRI-Guided thrombolysis for stroke with unknown time of onset. N Engl J Med [Internet]. 2018 [citado 07 Nov 2020];379(7):611-622. Disponible en: https://doi.org/10.1056/NEJMoa1804355
Campbell BC, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus Alteplase before thrombectomy for ischemic stroke. N Engl J Med [Internet]. 2018 [citado 10 Nov 2020];378(17):1573-1582. Disponible en: https://doi.org/10.1056/NEJMoa1716405
Marmagkiolis K, Hakeem A, Cilingiroglu M, Gundogdu B, Iliescu C, Tsitlakidou D, et al. Safety and efficacy of stent retrievers for the management of acute ischemic stroke: comprehensive review and meta-analysis. JACC Cardiovasc Interv [Internet]. 2015 [citado 10 Nov 2020];8:1758–1765. Disponible en: https://doi.org/10.1016/j.jcin.2015.07.021
Bush CK, Kurimella D, Cross LJS, Conner KR, Martin-Schild S, He J, et al. Endovascular treatment with stent-retriever devices for acute ischemic stroke: a meta-analysis of randomized controlled trials. PLoS One [Internet]. 2016 [citado 10 Nov 2020];11(1):e0147287. Disponible en: https://doi.org/10.1371/journal.pone.0147287
Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical thrombectomy in acute ischemic stroke: A Systematic Review. Can J Neurol Sci [Internet]. 2016 [citado 10 Nov 2020];43(4):455-460. Disponible en: https://doi.org/10.1017/cjn.2016.30
Health Quality Ontario. Mechanical thrombectomy in patients with acute ischemic stroke: a health technology assessment. Ont Health Technol Assess Ser [Internet]. 2016 [citado 11 Nov 2020];16(4):179. Disponible en: https://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Journal-Ontario-Health-Technology-Assessment-Series/hta-mechanical-thrombectomy
Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, et. al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med [Internet]. 2020 [citado 11 Nov 2020];382(21):1981-1993. Disponible en: https://doi.org/10.1056/NEJMoa2001123
Achit H, Soudant M, Hosseini K, Bannay A, Epstein J, Bracard S, et al. Cost-Effectiveness of thrombectomy in patients with acute ischemic stroke: The THRACE Randomized Controlled Trial. Stroke [Internet]. 2017 [citado 11 Nov 2020];48(10):2843-2847. Disponible en: https://doi.org/10.1161/STROKEAHA.117.017856
Balami JS, Sutherland BA, Edmunds LD, Grunwald IQ, Neuhaus AA, Hadley G, et al. A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke. Int J Stroke [Internet]. 2015 [citado 11 Nov 2020];10(8):1168-1178. Disponible en: https://doi.org/10.1111/ijs.12618
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2022-01-05
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Martínez-Zarazúa C, Torres-Rivera MG. Thrombolytic versus endovascular management in ischemic stroke. Rev 16 de abril [Internet]. 2022 Jan. 5 [cited 2024 Dec. 18];61(283):e1148. Available from: https://rev16deabril.sld.cu/index.php/16_04/article/view/1148
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