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Director: Terceño Izaga, Mikel
López-Bermejo, Abel
Altres contribucions: Universitat de Girona. Facultat de Medicina
Autor: Singh Kaur, Núria
Data: novembre 2021
Resum: BACKGROUNDFor patients with large vessel occlusion (LVO) strokes, it is unknown whether endovasculartreatment (EVT) treatment alone compared with intravenous thrombolysis plus EVT(standard treatment) can achieve similar functional and safety outcomes.OBJECTIVESTo investigate whether EVT plus placebo is non-inferior to intravenous thrombolysisfollowed by EVT for achieving functional independence at 90 days (modified Rankin Scale0-2) among patients with acute ischemic stroke with occlusion of the M2 segment of themiddle cerebral artery (MCA).Secondary objectives to assess efficacy include investigating recanalization rates and finalinfarct volume at 72h measured by diffusion-weighted imaging (DWI).Secondary objectives to assess safety include symptomatic intracerebral haemorrhage(sICH), any intracerebral haemorrhage (ICH), any other haemorrhages and mortality rates.METHODSRandomized, multicentric, prospective, double-blind, non-inferiority, controlled clinicaltrial.Intervention will be performed internationally in 50 stroke centres from Europe, USA andCanada
Format: application/pdf
Accés al document: http://hdl.handle.net/10256/21641
Llenguatge: eng
Drets: Attribution-NonCommercial-NoDerivatives 4.0 International
URI Drets: http://creativecommons.org/licenses/by-nc-nd/4.0/
Matèria: Atac isquèmic transitoriÂ-- Tractament
Transient ischemic attackÂ-- Treatment
Vasos sanguinis -- Cirurgia
Blood-vessels -- Surgery
TerÃpia trombolítica
Thrombolytic therapy
Títol: Endovascular treatment plus placebo versus endovascular treatment plus intravenous thrombolysis in acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a multicenter randomized clinical trial: the M-TWO Trial
Tipus: info:eu-repo/semantics/bachelorThesis
Repositori: DUGiDocs

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DUGi: Ítem | DUGiDocs - Endovascular treatment plus placebo versus endovascular treatment plus intravenous thrombolysis in acute ischemic stroke with occlusion of the M2 segment of the middle cerebral artery: a multicenter randomized clinical trial: the M (2024)

FAQs

What is endovascular therapy for ischemic stroke? ›

The treatment involves placing a catheter into the brain and removing the clot that's causing the stroke. Endovascular therapy must be done within six to eight hours of the onset of a stroke, depending on the location. Endovascular treatment can restore blood flow within minutes.

What is the two year outcome after endovascular treatment for acute ischemic stroke? ›

The cumulative 2-year rate of death was 26.0% in the intervention group and 31.0% in the control group (adjusted hazard ratio for death, 0.9; 95% CI, 0.6 to 1.2; P=0.46) (Figure 2).

What is the effect of first pass reperfusion on outcome after endovascular treatment for ischemic stroke? ›

Background First pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent ...

In which situations has endovascular therapy been shown to be effective? ›

Endovascular therapy (EVT) is effective in the treatment of large vascular occlusive stroke. However, many factors are associated with the outcomes of acute ischemic stroke (AIS) after EVT. This study aimed to identify the main factors related to the prognosis of AIS patients after EVT.

What are the five year outcomes after endovascular treatment for large vessel occlusion stroke? ›

At 5 years, 190 patients (28.9%) had an excellent outcome, 261 patients (39.7%) had a favorable functional outcome, 317 patients (48.2%) died and 129 (28.2%) had stroke recurrence.

What is the best intervention for ischemic stroke? ›

The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start.

What are the 2 major acute treatments approved for ischemic stroke? ›

There are two modalities of treatment available for treatment of acute ischemic stroke. Intravenous thrombolysis and mechanical thrombectomy.

What is the recovery time for an ischemic stroke? ›

1–3 Months Post-Stroke

“The first three months after a stroke are the most important for recovery and when patients will see the most improvement,” says Raghavan. During this time, most patients will enter and complete an inpatient rehabilitation program, or make progress in their outpatient therapy sessions.

Is ischemic stroke damage permanent? ›

Sometimes, the disruption of blood flow can result in difficulty with speech, face or muscle weakness, or loss of coordination. Other times, it may cause cognitive problems. It's important for ischemic stroke to be diagnosed and treated quickly to unblock blood flow before permanent damage can occur.

What is the mortality rate for ischemia reperfusion injury? ›

Ischemic and reperfusion injuries of the heart underlie the pathogenesis of acute myocardial infarction (AMI) and sudden cardiac death. The mortality rate is still high and is 5–7% in patients with ST-segment elevation myocardial infarction.

What are the complications of reperfusion therapy? ›

These complications may manifest as penumbral damage, ischemia expansion, hemorrhagic transformation, malignant cerebral edema and herniation, seizures, and disruption of the BBB, leading to secondary brain injury and neurological deterioration.

What are the reasons for failed endovascular Recanalization attempts in stroke patients? ›

Major reasons for failed recanalization were difficult anatomical access (eg, cervical artery stenosis or elongation) and hard or resistant occlusion reflecting hard clots or pre-existing intracranial atherosclerotic stenosis.

What are the complications of endovascular treatment? ›

Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or ...

What is considered a main benefit of endovascular? ›

Endovascular coiling is used to treat cerebral aneurysms. The main goal is prevention of rupture in unruptured aneurysms, and prevention of rebleeding in ruptured aneurysms by limiting blood circulation to the aneurysm space.

What is the maximum time from the last known normal when endovascular therapy can be performed? ›

For eligible LVO patients, it is recommended to undergo MT as soon as possible, ideally within 6 to 16 hours from their last known normal.

What is endovascular revascularization for ischemic stroke? ›

Early recanalization of occluded vessels in acute ischemic stroke (AIS) either by intravenous thrombolysis or endovascular revascularization has been shown to be associated with improved clinical outcome and reduced mortality. Initial works on endovascular treatment (EVT) of AIS was published in the 1980s.

What is an example of endovascular therapy? ›

From there, the surgeon will perform an endovascular treatment, such as balloon angioplasty or stenting. In balloon angioplasty, the blocked artery is opened by pressing plaque against the vessel wall with a balloon inserted with a catheter.

What is the difference between endovascular and neurosurgery? ›

Neurosurgery is a type of surgery that treats problems of the brain and nerves. Endovascular neurosurgery is a subspecialty within neurosurgery. These healthcare providers are trained in both neurosurgery and radiology. Then they do a neurosurgery residency at a hospital.

What is the difference between endovascular and vascular surgery? ›

Vascular surgery involves traditional open surgical techniques, while endovascular surgery employs minimally invasive procedures using catheters, stents, and other devices to treat vascular conditions.

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