Ramsha Malik, Ayeesha Kamran Kamal.
State of endovascular therapy for acute ischaemic stroke.
J Pak Med Assoc Jan ;64(4):477-8.

Acute strokes result from an occlusion of intracranial vessels by either a thrombus or embolus. The aim of acute treatment of ischaemic strokes is removal of this occlusion and recanalization of the vessel.The modes of therapy available include the administration of intravenous tissue plasminogen activator (tPA) or endovascular therapy involving either intraarterial thrombolysis with recombinant tPA, mechanical clot disruption or clot retrieval. There has been much debate over the effectiveness of the two treatment modalities in terms of rescuing the penumbra region and long term survival free of complications. Three randomized control trials were conducted to investigate this theory. Before these 3 trials, studies had suggested the superiority of endovascular therapy over intravenous tPA. But there was no mortality data from randomized studies and the long term outcome of the survivors was not known. The three trials, namely Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) trial, Local versus Systemic Thrombolysis for Acute Ischemic Stroke (SYNTHESIS Expansion) trial and Interventional Management of Stroke III (IMS III) were conducted independently at multiple centers around the world. We present below the conclusions drawn from these randomized control trials.

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