2023 Volume 40 Issue 5 Pages 684-689
Advance in acute recanalization therapy : Mechanical thrombectomy (MT) for acute large vessel occlusion become a standard therapy. In 2022, RESCUE–Japan LIMIT revealed that the efficacy of MT among patients with large ischemic core (ASPECTS 3–5). Furthermore, ATTENTION and BAOCHE trials extended the MT indication to the posterior circulation stroke. Regarding the direct MT versus bridging with thrombolysis, final results of SWIFT–DIRECT and DIRECT SAFE were published. The integrated analysis of the 6 trials by the European Stroke Organization–European Society for Minimally Invasive Neurological Therapy (ESO–ESMIT), did not show non–inferiority of direct MT. CHOICE verified the efficacy of intra–arterial alteplase after effective recanalization and showed an increase in the number of patients with a good outcome at 90 days. AURORA was an integrated analysis of late time window MT, and showed 2.54 times better outcome for the MT group. The AcT trial compared the mRS 0–1 at 90 days after tenecteplase (0.25 mg/kg) and alteplase (0.9 mg/kg) in patients with stroke within 4.5 hours, and showed non–inferiority of tenecteplase versus alteplase.
Advance in antithrombotic therapy : TIMING is a randomized controlled trial of DOAC initiation for cerebral infarction with NVAF, which demonstrated non–inferiority of early initiation to late initiation for the composite endpoint of recurrent stroke, symptomatic intracranial hemorrhage, or all–cause mortality during a 90–day observation period. An integrated analysis of the SAMURAI–NVAF and RELAXED studies was reported from Japan. As a result, the 1–2–3–4 days rule was proposed as the timing for starting DOAC for transient ischemic attack, mild stroke (NIHSS ≤7), moderate stroke (8–15), and severe stroke (≥16), respectively.
Blood pressure control : A meta–analysis conducted by the Blood Pressure in Acute Stroke investigators showed no improvement in outcome with enhanced antihypertensive therapy, but did show some inhibition of hematoma expansion and limited improvement in outcome.
