The New Era of Endovascular Therapy in the Treatment of Acute Stroke

Czech version

Authors: M. Tinková; P. Malý
Authors‘ workplace: Komplexní cerebrovaskulární centrum, Neurologické oddělení, ÚVN – VFN Praha
Published in: Cesk Slov Neurol N 2016; 79/112(2): 152-159
Category: Review Article

Overview

The endovascular therapy (EVT) is the most efficacious treatment for recanalisation of large vessel artery occlusion. Recently published prospective randomized controlled trials (RCT) demonstrated better outcomes with combined EVT and intravenous thrombolysis (IVT) versus IVT alone in the treatment of proximal arterial occlusion in the anterior cerebral circulation. In this article seven of these RCT studies published in 2014 - 2015 are reviewed. In the latter part of the article, the factors influencing final clinical outcome are discussed: age, comorbidities, hyperglycemia on admission, signs of early ischemia as evaluaed by Alberta Stroke Program Early CT Score (ASPECTS), absence of collateral supply, time before recanalisation occurs and application general anesthesia. The careful selection of patients indicated for EVT is of utmost importance for the succes of therapy.

Key words:
acute ischemic stroke – endovascular therapy – mechanical thrombectomy – stent-retriever

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.

Sources

1. Kidwell CH, Jahan R, Gornbeins J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013;368(10):914– 23. doi: 10.1056/ NEJMoa1212793.

2. Broderick JP, Palesh YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Eng J Med 2013;368(10):893– 6. doi: 10.1056/ NEJMoa1214300.

3. Ciccone A, Valvassori L. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013;368(25):2433– 4.

4. Fargen KM, Neal D, Fiorella DJ, et al. A meta-analysis of prospective randomized controlled trial evaluating endovascula terapies for acute ischemic stroke. J Neurointerv Surg 2015;7(2):84– 9. doi: 10.1136/ neurintsurg-2014-011543.

5. Canavero I, Cavallini A, Denaro F, et al. Reperfusion strategies for acute ischaemic stroke from past to present. An overview towards future pespectives. EMJ Neurol 2015;3(1):75– 81.

6. Wisco D, Chino K, Saqqur M, et al. Addition of hyperacute MRI aids in patient selection, decreasing the use o endovascular stoke therapy. Stroke 2014,45(2):467– 72. doi: 10.1161/ STROKEAHA.113.003880.

7. Chimowitz MI. Game changer for endovascular treatment of acute ischemic stroke? J Neurointerv Surg 2014;6(4):252– 3. doi: 10.1136/ neurintsurg-2014-011187.

8. Berkhemer OA, Puck SS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Eng J Med 2015;372(1):11– 20. doi: 10.1056/ NEJMoa1411587.

9. Fiorella DJ, Fargen KM, Mocco J, et al. Thrombectomy for acute ischemic stroke: an evidence-based treatment. J Neurointerv Surg 2015;7(5):314– 6. doi: 10.1136/ neurintsurg-2015-011707.

10. Demchuk AM, Goyal M, Menon BK, et al. Endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalisation times (ESCAPE) trial metodology. Int J Stroke 2015;10(3):429– 38. doi: 10.1111/ ijs.12424.

11. Saver JL, Goyal M, Bonafe A, et al. Solitaire TM with the intention as primary endovascular treatment for acute ischemic stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularisation device with IV tPA with IV tPA alone in acute ischemic stroke. Int J Stroke 2015;10(3):439– 48. doi: 10.1111/ ijs.12459.

12. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372(11):1009– 18. doi: 10.1056/ NEJMoa1414792.

13. Molina CA, Chamorro A, Rovia A et al. REVASCAT: a randomized trial of revascularisation with solitaire FR device vs. best medical therapy in the treatment of acute stroke due to anterior ciculation large vessel occlusion presenting within eight-hours of symptom onset. Int J Stroke 2015;10(4):619– 26. doi: 10.1111/ ijs.12157.

14. Bracard S, Investigators T. The contribution of intra-arterial thrombectomy in acute ischemic stroke patients treated with intravenous thrombolysis. European Stroke Organisation Conference 2015. Glasgow, UK.

15. Mocco J, Khatri P, Zaidat O. The THERAPY trial: the randomized, concurrent controlled trial to assess the Penumbra Systems’safety and effectiveness in the treatment of acute stroke. European Stroke organisaton Conference 2015. Glasgow, UK.

16. Ding D. Endovascular mechanical thrombectomy for acute ischemic stroke: a new standard of care. J Stroke 2015;17(2):123– 6. doi: 10.5853/ jos.2015.17.2.123.

17. Anastasian ZH. Anaesthetic management of the patient with acute ischaemic stroke. Br J Anaesth 2014;113(Suppl 2):ii9– 16. doi: 10.1093/ bja/ aeu372.

18. Hussein HM, Georgiadis AL, Vazquez , et al. Occurence and predictors of futile recanalisation following endovascular treatment among patients with acute ischemic stroke. AJNR 2010;31(3):454– 8. doi: 10.3174/ ajnr.A2006.

19. Davis MJ, Menon BK, Baghirzada LB, et al. Anesthetic management and outcome in patients during endovascular therapy fo acute stroke. Anesthesiology 2012;116(2):396– 405. doi: 10.1097/ ALN.0b013e318242a5d2.

20. Chen M. Cost-effectivenes of endovascular therapy for acute ischemii stroke. Neurology 2012;79(Suppl 1): S16– 21.

21. Lansberg MG, Straka M, Kemp S, et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol 2012;11(10): 860– 7. doi: 10.1016/ S1474-4422(12)70203-X.

22. Lund CG, Aamodt AH, Russell D. Patient selection for intra-arterial cerebral revascularisation in acute ischemic stroke. Acta Neurol Scand 2013;127(Suppl 1):65– 8.

23. Manning NW, Cambell BC, Oxley TJ, et al. Acute ischemic stroke. Time, penumbra and reperfusion. Stroke 2014;45(2):640– 4. doi: 10.1161/ STROKEAHA.113.003798.

24. Sanelli PC, Sykes JB, Ford AL, et al. Imaging and treatment of patients with acute stroke: an evidence-based review. AJNR AM J Neuroradiol 2014;35(6):1045– 51. doi: 10.3174/ ajnr.A3518.

25. Leifer D, Bravata DM, Connors JJ, et al. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attacks Coalition comprehensive stroke center recommendations. Stroke 2011;42(3):849– 77. doi: 10.1161/ STR.0b013e318208eb99.

26. Mlynash M, Lansberg MG, De Silva DA, et al. Refining the definition of the malignant profile. Insights from the DEFUSE-EPITHET pooled data set. Stroke 2011;42(5):1270– 5. doi: 10.1161/ STROKEAHA.110.601609.

27. Mishra NK, Christensen S, Wouters A, et al. Reperfusion of very low cerebral blood volume lesion predicts parenchymal hematoma after endovascular therapy. Stroke 2015;46(5):1245– 9. doi: 10.1161/ STROKEAHA.114.008171.

28. Mokin M, Levy EI. Guest editorial: endovascular treatment of acute ischemic stroke: what’s next? Neurosurgery 2015;76(3):235– 8. doi: 10.1227/ NEU.0000000000000647.

29. Balami JS, Sutherland BA, Edmunds LD, 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 2015;10(8):1168– 78. doi: 10.1111/ ijs.12618.

30. Balucani C, Grotta JC. Selecting stroke patients for intra-arterial therapy. Neurology 2012;78(10):755– 61. doi: 10.1212/ WNL.0b013e318248e558.

31. Becktepe JS, You SJ, Berkefeld J, et al. Clinical outcome after mechanical recanalisation as mono- or adjunctive therapy in acute stroke: importance of time to recanalisation. Cerebrovasc Dis 2011;32(3):211– 8. doi: 10.1159/ 000328814.

32. Brinjikji W, Rainstein AA, Kallmes DK, et al. Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke. Stroke 2011;42(6):1648– 52. doi: 10.1161/ STROKEAHA.110.607952.

33. Flint AC, Kamel H, Rao VA, et al. Validation of the totaled health risks in vascular events (THRIVE) score for outcome prediction in endovascular stroke treatment. Int J Stroke 2014; 9(1):32– 9. doi: 10.1111/ j.1747-4949.2012.00872.x.

34. Nam J, Jing H, O’Reilly D. Intra-arterial thrombolysis vs. standard treatment or intravenous thrombolysis in adults with acute ischemic stroke: a systematic review and meta-analysis. Int J Stroke 2015;10(1):13– 22. doi: 10.1111/ j.1747-4949.2012.00914.x.

35. Rai AT, Raghuram K, Domico J, et al. Pre-intervention triage incorporating perfusion imaging improves outcomes in patients undergoing endovascular stroke therapy: a comparison with the device trials. J Neurointervent Surg 2012;5(2):121– 7. doi: 10.1136/ neurintsurg-2011-010189.

36. Ribo M, Flores A, Rubiera M, et al. Extending the time window for endovascular procedures according to collateral pial circulation. Stroke 2011;42(12):3465– 9. doi: 10.1161/ STROKEAHA.111.623827.

37. Rubiera M, Ribo M, Pagola J, et al. Bridging intravenous-intra-arterial rescue strategy increases recanalisation and the likelihood of a good outcome in nonresponder intravenous tissue plasminogen activator-treated patients. Stroke 2011;42(4):993– 7. doi: 10.1161/ STROKEAHA.110.597104.

38. Turk AS, Frei D, Fiorella D, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 2014;6(4):260– 4. doi: 10.1136/ neurintsurg-2014-011125.

39. Bang OY, Saver JL, Kim SJ, et al. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke 2011;42(3):693– 9. doi: 10.1161/ STROKEAHA.110.595256.

40. Goldemund D, Mikulík R, Reif M. Trombolytická terapie mozkového infarktu. Kardiol Rev 2008;10(4):168– 76.

41. Molina CA. Futile recanalisation in mechanical embolectomy trials. A call to improve selection of patients for revascularisation. Stroke 2010;41(5):842– 3. doi: 10.1161/ STROKEAHA.110.580266.

42. Woo HH, Arthur AS, Mocco J, et al. MR CLEAN: past the tipping point of clinical equipoise. J Neurosurg 2015;123(1):101– 2. doi: 10.3171/ 2015.2.JNS15284.

43. Hacke W. The results of the recent thrombectomy trias may influence stroke care delivery: are you ready? Int J Stroke 2015;10(5):646– 50. doi: 10.1111/ ijs.12541.

44. Abou-Chebl A. Endovascular treatment of acute ischemic stroke may be safely peformed with no time window limit in appropriately selected patients. Stroke 2010;41(9):1996– 2000. doi: 10.1161/ STROKEAHA.110.578997.

45. Zeevi N, Kuchel GA, Lee NS, et al. Interventional stroke therapies in the elderly: are we helping? AJNR Am J Neuroradiol 2012;33(4):638– 42. doi: 10.3174/ ajnr.A2845.

46. Chandra RV, Leslie-Mazwi TM, Oh DC, et al. Elderly patients are at higher risk for poor outcomes after intra-arterial therapy. Stroke 2012;43(9):2356– 61. doi: 10.1161/ STROKEAHA.112.650713.

47. Zaidi SF, Anghaebrahim A, Urra X, et al. Final infarct voume is a stronger predictor of outcome than recanalisation in patiens with proximal middle cerebral artery occlusion treated with endovascular therapy. Stroke 2012;43(12):3238– 44. doi: 10.1161/ STROKEAHA.112.671594.

48. Ghobrial GM, Chalouhi N, Rivers L, et al. Multimodal endovascular management of acute ischemic stroke in patients over 75 years old is safe and effective. J Neurointervent Surg 2013;5(Suppl 1):i33– 37. doi: 10.1136/ neurintsurg-2012-010422.

49. Saposnik G, Fang J, Kapral MK, et al. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke 2012;43(5):1315– 22. doi: 10.1161/ STROKEAHA.111.646265.

50. Václavík D, Mikulík R, Kadlecová P, et al. Prediktory symptomatického intracerebrálního krvácení po systémové trombolýze mozkového infarktu. Cesk Slov Neurol N 2012;75/ 108(6):715– 20.

51. Choi JY, Kim EJ, Lee SE, et al. Conventional enhancement CT: a valuable tool for evaluating pial collateral flow in acute ischemic stroke. Cerebrovasc Dis 2011;31(4):346– 52. doi: 10.1159/ 000322602.

52. Vora NA, Shook SJ, Schumacher HCh, et al. A 5-item scale to predict stroke outcome after cortical middle cerebral artery territory infarction. Stroke 2011;42(3):645– 9. doi: 10.1161/ STROKEAHA.110.596312.

53. Šaňák D, Herzig R, Horák D, et al. Predictors of good clinical outcome in acute stroke patients treated with inravenous thrombolysis. Acta Neurol Scand 2011;123(5):339– 44. doi: 10.1111/ j.1600-0404.2010.01401.x.

54. Castano C, Dorado L, Guerrero CH, et al. Mechanical thrombecotmy with the Solitaire AB Device in large artery occlusions of the anterior circulation. Stroke 2010;41(8):1836– 40. doi: 10.1161/ STROKEAHA.110.584904.

55. Singer OC, Berkefeld J, Lorenz MW, et al. Risk of symptomatic intracerebral hemorrhage in patients treated with intra-arterial thrombolysis. Cerebrovasc Dis 2009,27(4):368– 74. doi: 10.1159/ 000202427.

56. Cucchiara B, Kasner SE, Tanne D, et al. Factors associated with intracerebral hemorrhage after thrombolytic therapy for ischemic stroke. Stroke 2009;40(9):3067– 72. doi: 10.1161/ STROKEAHA.109.554 386.

57. Khatri P, Wechsler LR, Broderisk JP. Intracranial hemorrhage associated with revascularisation therapies. Stroke 2007;38(2):431– 40.

58. Strbian D, Engelter S, Michel P, et al. Symptomaic intracranial hemorrhage after stroke thrombolysis: The SEDAN Score. Ann Neurol 2012;71(5):634– 41. doi: 10.1002/ ana.23546.

59. Kreisel SH, Berschin UM, Hammes HP, et al. Pragmatic management of hyperglycaemia in acute ischamic stroke: safety and feasibility of intensiv intravenous insulin treatment. Cerebrovasc Dis 2009;27(2):167– 75. doi: 10.1159/ 000185608.

60. Alawneh JA, Mustafa RR, Baron JC. Hemodynamic factors and perfusion abnormalities in early neurological deterioration. Stroke 2009;40(6):e443– 50. doi: 10.1161/ STROKEAHA.108.532465.

61. Paciaroni M, Agnelli G, Corea F, et al. Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome. Stroke 2008;39(8):2249– 56. doi: 10.1161/ STROKEAHA.107.510321.

62. Jain AR, Jain M, Kanthala AR, et al. Association of CT perfusion parameters with hemorrhagic transformation in acute ischemic stroke. AJNR Am J Neuroradiol 2013;34(10): 1895– 900. doi: 10.3174/ ajnr.A3502.

63. Rha JH, Saver JL. The impact of recanalisation on ischemic stroke outcome. Stroke 2007,38(3):967– 73.

64. Tan IY, Demchuk AM, Hopyan J, et al. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 2009;30(3):525– 31. doi: 10.3174/ ajnr.A1408.

65. Frolich AM, Schrader D, Klotz E, et al. 4D CT Angiography more closely defines intracranial thrombus burden than singlephase CT Angiography. AJNR Am J Neuroradiol 2013;34(10):1908– 13. doi: 10.3174/ ajnr.A3533.

66. Psychogios MN, Schramm P, Frolich AM, et al. Alberta Stroke Program Early CT Scale evaluation of multimodal computed tomography in predicting clinical outcomes of stroke patients treated with aspiration thrombectomy. Stroke 2013;44(8):2188– 93. doi: 10.1161/ STROKEAHA.113.001068.

67. Demchuk AM, Hill MD, Barber PA, et al. Importance of early ischemic CT changes using ASPECTS in NINDS rtPA stroke study. Stroke 2005;36(10):2110– 5.

68. Okazaki S, Moriwaki H, Minematsu K, et al. Extremely early computed tomography signs in hyperacute ischemic stroke as a predictor of parenchymal hematoma. Cerebrovasc Dis 2008;25(3):241– 6. doi: 10.1159/ 000113862.

69. Sun CH, Connelly K, Nogueira RG, et al. ASPECTS decay during interfacility transfer predicts patient outcomes in endovascular reperfusion for ischemic stroke: a unique assessment of dynamic physiologic change over time. J Neuroinerv Surg 2015;7(1):22– 6. doi: 10.1136/ neurintsurg-2013-011048.

70. González RG, Copen WA, Schaefer PW, et al. The Massachusetts general hospital acute stroke imaging algorithm: experience and evidence based approach. J Neurointerv Surg 2013;5(Suppl 1):i7– 12. doi: 10.1136/ neurintsurg-2013-010715.

71. Yoo AJ, Barak ER, Copen WA, et al. Combining acute diffusion-weighted imaging and mean transit time lesion volumes with National Institutes of Health StrokeScale score improves the prediction of acute stroke outcome. Stroke 2010,41(8):1728– 35. doi: 10.1161/ STROKEAHA.110.582874.

72. Campbell BC, Yassi N, Ma H, et al. Imaging selection in ischemic stroke: feasibility of automated CT perfusion anylysis. Int j Stroke 2015;10(1):51– 4. doi: 10.1111/ ijs.12381.

73. Gory B, Riva R, Derex L, et al. Value of perfusion CT-guided recanalisation therapy in acute ischemic stroke patients. Cerebrovasc Dis 2014;37(5):389– 90. doi: 10.1159/ 000362923.

74. Hom J, Dankbaar JW, Soarez BP, et al. Blood-brain barrier permeability asessed by perfusion CT predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. AJNR Am J Neuroradiol 2011;32(1):41– 8. doi: 10.3174/ ajnr.A2244.

75. Jackson D, Earnshaw SR, Farkouh R, et al. Cost-effectiveness of CT Perfusion for selecting patients for intravenous thrombolysis: a US hospital perspective. AJNR Am J Neuroradiol 2010;31(9):1669– 774. doi: 10.3174/ ajnr.A2138.

76. Gasparotti R, Grassi M, Mardighian D, et al. Perfusion CT in patients with acute ischemic stroke treated with intra-arterial thrombolysis: predictive value of infarct core size on clinical outcome. AJNR Am J Neuroradiol 2009;30(4):722– 7. doi: 10.3174/ ajnr.A1439.

77. Prabhakaran S, Soltanolkotab M, Honarmand AR, et al. Perfusion-based selection for endovascular reperfusion therapy in anterior circulation acute ischemic stroke. AJNR Am J Neuroradiol 2014;35(7):1303– 8. doi: 10.3174/ ajnr.A3889.

78. Román LS, Obach V, Blasco J, et al. Single-Cnter expereince of cerebral artery thrombectomy using the TREVO Device in 60 patients with acute ischemic stroke. Stroke 2012;43(6):1657– 9. doi: 10.1161/ STROKEAHA.111.640011.

79. Zhu G, Michel P, Jovin T, et al. Prediction of recanalisation in acute stroke patients receiving intravenous and endovascular revascularisation therapy. Int J Stroke 2015;10(1):28– 36. doi: 10.1111/ ijs.12312.

80. Krajina A, Chovanec V, Krajíčková D, et al. Rekanalizace akutních uzávěrů mozkových tepen pomocí retrahovatelného stentu. Cesk Slov Neurol N 2012;75/ 108(1):75– 9.

81. Bang OY, Saver JL, Kim SJ, et al. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke 2011;42(8): 2235– 9. doi: 10.1161/ STROKEAHA.110.604603.

82. Angermaier A, Langner S, Kirsch M, et al. CT-Angiographic collateralisation predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis 2011;31(2):177– 84. doi: 10.1159/ 000321868.

83. Menon BK, Smith EE, Modi J, et al. Regional leptomeningeal score on CT Angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011;32(9):1640– 5. doi: 10.3174/ ajnr.A2564.

84. Nambiar V, Sohn SI, Almekhlafi NA, et al. CTA collateral status and response to recanalisation in patients with acute ischemic stroke. AJNR Am J Neuroradiol 2014;35(5): 884– 90. doi: 10.3174/ ajnr.A3817.

85. Miteff F, Levi CR, Bateman GA, et al. Tde independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009;132(8):2231– 8. doi: 10.1093/ brain/ awp155.

86. Tan IY, Demchuk AM, Hopyan J, et al. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 2009;30(3):525– 31. doi: 10.3174/ ajnr.A1408.

87. Volný O, Mikulík R. Kolaterální cirkulace mozku – potenciální cíl terapie mozkových infarktů. Cesk Slov Neurol N 2013;76/ 109(3):307– 14.

88. Elijovich L, Goyal N, Mainali S, et al. CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review. J Neurointerv Surg. In press 2016.

89. Souza LC, Yoo AJ, Chaudhry ZA, et al. Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke. AJNR Am J Neuroradiol 2012;33(7):1331– 6. doi: 10.3174/ ajnr.A2985.

90. Mazighi M, Serfaty JM, Labreuche J, et al. Comparison of intravenous alteplase with a combined intravenous-endovascular approach in patiens with stroke and confirmed arterial occlusion (RECANALISE Study): a prospective cohort study. Lancet Neurol 2009;8(9):802– 9. doi: 10.1016/ S1474-4422(09)70182-6.

91. Almekhlafi MA, Eesa M, Menon BK, et al. Ultrashort imaging to reperfusion time interval arrests core expansion in endovascular therapy for acute ischemic stroke. J Neurointerv Surg 2013;5(Suppl 1):i58– 61. doi: 10.1136/ neurintsurg-2012-010486.

92. Spiotta AM, Vargas J, Turner R, et al. The golden hour of stroke intervention: effect of thrombectomy procedural time in acute ischemic stroke on outcome. J Neurointerv Surg 2014;6(7):511– 6. doi: 10.1136/ neurintsurg-2013-010726.

93. Abou Chebl A, Lin R, Hussain MS, et al. Conscious sedation verusu general anesthesia during endovascular therapy for acute anterior circulation stroke. Stroke 2010;41(6):1175– 9. doi: 10.1161/ STROKEAHA.109.574129.

94. van der Berg LA, Koelman DL, Berkhemer OA, et al. Type of anesthesia an differences in clinical outcome after intra-arterial treatment for acute ischemic stroke. Stroke 2015;46(5):1257– 62. doi: 10.1161/ STROKEAHA.115.008699.

95. Školoudík D, Kuliha M, Jonszta T, et al. Endovaskulární léčba ischemické cévní mozkové příhody. Cesk Slov Neurol N 2012;75/ 108(6):669– 83.

96. Krajina A, Krajíčková D. Role neuroradiologa v léčbě ischemických cévních mozkových příhod. Ces Radiol 2015;69(2):87– 92.

97. Henninger N, Lin E, Haussen DC, et al. Leukoaraiosis and sex predicts the hyperacute ischemic core volume. Stroke 2013;44(1):61– 7. doi: 10.1161/ STROKEAHA.112.679084.

98. Henninger N, Khan MA, Zhang J, et al. Leukoaraiosis predicts cortical infarct volume after distal middle cerebral artery occlusion. Stroke 2014;45(3):689– 95. doi: 10.1161/ STROKEAHA.113.002855.

99. Mono ML, Romagna L, Jung S, et al. Intra-arterial thrombolysis for acute ischemic stroke in octogenarians. Cerebrovasc Dis 2012;33(2):116– 22. doi: 10.1159/ 000333429.

100. Palumbo V, Boulanger JM, Hill MD, et al. Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke. Neurology 2007;68(13):1020– 4.

101. Hassan AE, Chaudhry SA, Miley JT, et al. Microcatheter to recanalisation (procedure time) predicts outcomes in endovascular treatment in patients with acute ischemic stroke: when do we stop? AJNR Am J Neuroradiol 2013;34(2):354– 9. doi: 10.3174/ ajnr.A3202.

102. Hughes S. New AHA/ ASA Guideline Recommends Endovascular Stroke Therapy. Available from URL: http:/ / www.medscape.com/ viewarticle/ 847211.