Clinical assessment tool used to quantify neurologic impairment caused by acute stroke
Predictor of short- and long-term outcome
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Management of Complications
Expected Outcomes
Selected References
Roaldsen MB et al: Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke. Cochrane Database Syst Rev. 12:CD010995, 2021
Weller JM et al: Endovascular treatment for acute stroke in cerebral amyloid angiopathy. Stroke. 52(10):e581-5, 2021
Campbell BCV et al: Stroke. Lancet. 396(10244):129-42, 2020
Herpich F et al: Management of acute ischemic stroke. Crit Care Med. 48(11):1654-63, 2020
Sairanen T et al: Should we thrombolyse prior to endovascular treatment in acute stroke? Clin Neurol Neurosurg. 177:117-22, 2019
Berkhemer OA et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 372(1):11-20, 2015
Goyal M et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 372(11):1019-30, 2015
Saver JL et al: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 372(24):2285-95, 2015
Sheth SA et al: M2 occlusions as targets for endovascular therapy: comprehensive analysis of diffusion/perfusion MRI, angiography, and clinical outcomes. J Neurointerv Surg. 7(7):478-83, 2015
Campbell BC et al: A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy (EXTEND-IA). Int J Stroke. 9(1):126-32, 2014
Nguyen TN et al: Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry. Stroke. 45(1):141-5, 2014
Davis MJ et al: Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology. 116(2):396-405, 2012
Saver JL et al: Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 380(9849):1241-9, 2012
Konstas AA et al: CT perfusion imaging of acute stroke: the need for arrival time, delay insensitive, and standardized postprocessing algorithms? Radiology. 254(1):22-5, 2010
Konstas AA et al: Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: Theoretic basis. AJNR Am J Neuroradiol. 30(4):662-8, 2009
Konstas AA et al: Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol. 30(5):885-92, 2009
Hurst RW et al: Interventional Neuroradiology. New York: Informa Healthcare, 2008
Smith WS et al: Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 39(4):1205-12, 2008
Gonzalez RG et al: Acute Ischemic Stroke: Imaging and Intervention. Berlin Heidelberg: Springer-Verlag, 2006
Hacke W et al: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 274(13):1017-25, 1995
Bonita R et al: Recovery of motor function after stroke. Stroke. 19(12):1497-500, 1988
van Swieten JC et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 19(5):604-7, 1988
Mahoney FI et al: Functional evaluation: the Barthel Index. Md State Med J. 14:61-5, 1965
Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 2(5):200-15, 1957
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Post Procedure
TERMINOLOGY
Definitions
Stroke: Acute loss of brain function(s) due to disturbance in blood supply to brain
Ischemic stroke: Embolic or thrombotic occlusion of arterial supply to brain (80% of strokes)
3 major clinical ischemic stroke subtypes
Large artery/atherosclerotic strokes (40-50%)
Cardioembolic disease (20-25%)
Lacunar infarction (20-30%)
Hemorrhagic stroke: Rupture/bleeding from brain blood vessel (15% of strokes)
Nontraumatic subarachnoid hemorrhage (5%)
Vasculitis
Venous infarction (< 1%)
Core infarct: Central area of severe ischemia/evolving infarction; unlikely to respond to treatment
Severely reduced to almost nonexistent blood flow
Inadequate supply of oxygen and glucose
Neuronal and glial necrosis
Irreversible damage; no response to reperfusion
Ischemic penumbra: Surrounding rim of ischemic tissue between normally perfused tissue and area of evolving infarction
Parenchymal tissue at risk of eventual infarction
Dependent upon collateral perfusion
Collateral circulation inadequate to maintain neuronal oxygen/glucose demand indefinitely
May remain viable for several hours
Target of acute stroke intervention
Endovascular therapy (ET): Standard of care for acute ischemic stroke with emergent large vessel occlusion (ELVO)
Clinical assessment tool used to quantify neurologic impairment caused by acute stroke
Predictor of short- and long-term outcome
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Management of Complications
Expected Outcomes
Selected References
Roaldsen MB et al: Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke. Cochrane Database Syst Rev. 12:CD010995, 2021
Weller JM et al: Endovascular treatment for acute stroke in cerebral amyloid angiopathy. Stroke. 52(10):e581-5, 2021
Campbell BCV et al: Stroke. Lancet. 396(10244):129-42, 2020
Herpich F et al: Management of acute ischemic stroke. Crit Care Med. 48(11):1654-63, 2020
Sairanen T et al: Should we thrombolyse prior to endovascular treatment in acute stroke? Clin Neurol Neurosurg. 177:117-22, 2019
Berkhemer OA et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 372(1):11-20, 2015
Goyal M et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 372(11):1019-30, 2015
Saver JL et al: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 372(24):2285-95, 2015
Sheth SA et al: M2 occlusions as targets for endovascular therapy: comprehensive analysis of diffusion/perfusion MRI, angiography, and clinical outcomes. J Neurointerv Surg. 7(7):478-83, 2015
Campbell BC et al: A multicenter, randomized, controlled study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy (EXTEND-IA). Int J Stroke. 9(1):126-32, 2014
Nguyen TN et al: Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry. Stroke. 45(1):141-5, 2014
Davis MJ et al: Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology. 116(2):396-405, 2012
Saver JL et al: Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 380(9849):1241-9, 2012
Konstas AA et al: CT perfusion imaging of acute stroke: the need for arrival time, delay insensitive, and standardized postprocessing algorithms? Radiology. 254(1):22-5, 2010
Konstas AA et al: Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: Theoretic basis. AJNR Am J Neuroradiol. 30(4):662-8, 2009
Konstas AA et al: Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol. 30(5):885-92, 2009
Hurst RW et al: Interventional Neuroradiology. New York: Informa Healthcare, 2008
Smith WS et al: Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 39(4):1205-12, 2008
Gonzalez RG et al: Acute Ischemic Stroke: Imaging and Intervention. Berlin Heidelberg: Springer-Verlag, 2006
Hacke W et al: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 274(13):1017-25, 1995
Bonita R et al: Recovery of motor function after stroke. Stroke. 19(12):1497-500, 1988
van Swieten JC et al: Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 19(5):604-7, 1988
Mahoney FI et al: Functional evaluation: the Barthel Index. Md State Med J. 14:61-5, 1965
Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 2(5):200-15, 1957
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