Managing hyperacute ischaemic stroke with interventional neuroradiology

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e857 (Published 13 February 2012) Cite this as: BMJ 2012;344:e857
  1. Alex M Mortimer, specialist registrar, neuroradiology,
  2. Marcus D Bradley, consultant, neuroradiology,
  3. Shelley A Renowden, consultant, neuroradiology
  1. 1Frenchay Hospital, Bristol BS16 1LE, UK
  1. alex.mortimer{at}nbt.nhs.uk

Provides effective vessel recanalisation but well designed trials are needed to establish the full spectrum of patients who could benefit

Ischaemic stroke causes an enormous amount of morbidity and mortality. In England and Wales about 53 000 people die each year after a stroke, and more than 450 000 people survive with severe disability, at an annual cost of £7bn (€8.4bn; $11bn).1 Many variables influence clinical outcome, including patient factors—such as the site of vessel occlusion, extent of thrombus, quality of collateral blood flow, and the patient’s clinical condition at presentation2 3 4—as well as therapeutic factors, such as the timing and effectiveness of recanalisation of the vessel. Early recanalisation is associated with a fourfold to fivefold increase in the chance of a person being able to function independently and a four to five times reduction in the odds of death.5 A recent review concluded that interventional neuroradiology techniques are highly effective in achieving vessel recanalisation.6 Such interventions may come to play a more central role in the management of hyperacute ischaemic stroke.

Currently, the standard treatment for patients presenting up to 4.5 hours after the ischaemic ictus is intravenous tissue plasminogen activator.7 This treatment is effective in only about half of distal vessel occlusions, but …

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