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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EAcute ischemic stroke is the leading cause of disability and the third-most common cause of death in the developed world. Time to treatment is crucial. Intravenous administration of tissue plasminogen activator within 3 hours of stroke is very effective. Developments in mechanical thrombectomy have made it an appealing treatment option.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute ischemic stroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emechanical thrombectomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emodified Rankin score\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etissue plasminogen activator\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EAcute ischemic stroke that results from large artery or small vessel atherosclerosis, atrial fibrillation, cervical artery dissection, and unknown etiologies is an important health concern. In the developed world, stroke is the leading cause of disability and the third-most common cause of death, according to Brian van Adel, MD, PhD, McMaster University, Hamilton, Ontario, Canada.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EClinical outcome of stroke is measured with the modified Rankin score. This scale ranks patients in terms of the degree of functional disability, with scores indicating unfavorable or favorable outcomes (ie, return to residence and resumption of some\/all aspects of daily living), with higher scores indicating progressively severe degrees of mobility limitation and ultimately death (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16832\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16832\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16832\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EModified Rankin Score\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EIschemia-related damage to the brain depends on the occlusion size, severity of blood flow reduction, duration of ischemia, efficiency of collateral circulation, blood flow restoration, and other factors. Thrombolysis and vessel recanalization are the only neuroprotective treatments supported by clinical evidence [Jauch EC et al. \u003Cem\u003EStroke\u003C\/em\u003E. 2013]. Recanalization can be done pharmaceutically and mechanically. However, vessel restoration does not always result in a good outcome.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ELikewise, the outcome of thrombolysis therapy through intravenously administered tissue plasminogen activator (tPA) can vary; it is especially effective when done soon after the ischemic stroke (within 3 hours). Protracted delays before tPA treatment increase the risk of symptomatic intracranial hemorrhage. tPA therapy yields good recanalization in occluded proximal vessels when applied to distal small clots in the intracranial circulation, but the outcome is not as good for other locations, including the basilar artery and internal carotid artery [Bhatia R et al. \u003Cem\u003EStroke\u003C\/em\u003E. 2010].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe time to treatment is crucial. Every minute that a large-vessel ischemic stroke is untreated, 2 million neurons die, and aging is accelerated by over 3 weeks [Saver JL. \u003Cem\u003EStroke\u003C\/em\u003E. 2006]. Current unknowns about acute ischemic stroke treatment through intravenous tPA include the rate of infarct progression, how collateral circulation influences recovery, and the influence of other factors, such as the composition of a clot.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ETreatment has advanced from catheter-mediated delivery of tPA for intra-arterial fibrinolysis in the late 1990s to ultrasound coil retrievers and aspiration in the next decade and to the use of various designs of stent retrievers in the past few years.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn particular, optimistic results have resulted through the use of newer stent retrievers in the following studies: MR CLEAN [\u003Ca href=\u0022\/external-ref?link_type=ISRCTN\u0026amp;access_num=ISRCTN10888758\u0022 class=\u0022external-ref external-ref-type-isrctn\u0022\u003EISRCTN10888758\u003C\/a\u003E; Fransen PSS et al. \u003Cem\u003ETrials\u003C\/em\u003E. 2014], ESCAPE [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01778335\u0026amp;atom=%2Fspmdc%2F15%2F21%2F14.2.atom\u0022\u003ENCT01778335\u003C\/a\u003E; Goyal M et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E. 2015], EXTEND-IA [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01492725\u0026amp;atom=%2Fspmdc%2F15%2F21%2F14.2.atom\u0022\u003ENCT01492725\u003C\/a\u003E; Campbell BCV et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E. 2015], SWIFT PRIME [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01657461\u0026amp;atom=%2Fspmdc%2F15%2F21%2F14.2.atom\u0022\u003ENCT01657461\u003C\/a\u003E; Saver JL et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E. 2015], and REVASCAT [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01692379\u0026amp;atom=%2Fspmdc%2F15%2F21%2F14.2.atom\u0022\u003ENCT01692379\u003C\/a\u003E; Jovin TG et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E. 2015]. These trials have spurred the recommended use of mechanical thrombectomy in addition to intravenous tPA to treat acute ischemic stroke with large-artery occlusions within 6 hours of symptom onset. Mechanical thrombectomy should be done as soon as possible.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/21\/14.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlglq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}