Výsledky intervenčních studií MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA, REVASCAT

Česká verzia

Authors: O. Volný ^1,2; A. Krajina ³; M. Bar ⁴; R. Herzig ⁵; D. Šaňák ⁶; A. Tomek ⁷; D. Školoudík ⁸; F. Charvát ⁹; D. Václavík ¹⁰; J. Neumann ^11,12; O. Škoda ^13,14; R. Mikulík ^1,2
Authors place of work: ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ¹; I. neurologická klinika LF MU a FN u sv. Anny v Brně ²; Komplexní cerebrovaskulární centrum, Radiologická klinika LF UK a FN Hradec Králové ³; Neurologická klinika LF OU a FN Ostrava ⁴; Komplexní cerebrovaskulární centrum, Neurologická klinika LF UK a FN Hradec Králové ⁵; Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc ⁶; Neurologická klinika 2. LF UK a FN v Motole, Praha ⁷; Ústav ošetřovatelství, FZV, UP v Olomouci ⁸; Radiodiagnostické oddělení, ÚVN – VFN Praha ⁹; Vzdělávací a výzkumný institut Agel, Neurologické oddělení, Vítkovická nemocnice, a. s., Ostrava ¹⁰; Iktové centrum, Neurologické oddělení, Krajská zdravotní, a. s., Nemocnice Chomutov ¹¹; Neurologická klinika LF UK a FN Plzeň ¹²; Iktové centrum, Neurologické oddělení, Nemocnice Jihlava ¹³; Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha ¹⁴
Published in the journal: Cesk Slov Neurol N 2016; 79/112(1): 100-110
Category: Guidelines
doi: https://doi.org/10.14735/amcsnn2016100

Summary

For the first time in cerebrovascular neurology there 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.

Key words:
stroke – endovascular thrombectomy – neurointerventions – imaging – acute care management – quality monitoring

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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