Page 17 - BH-3-3

Brain & Heart Advances in stroke treatment

it is generally reserved for cases with severe neurological Funding
deficits where no alternative therapies are available. For
MT, the guidelines support its use in eligible patients with None.
LVOs, as it avoids the systemic exposure associated with Conflict of interest
IVT and has demonstrated safety and efficacy. 41
The authors declare that they have no competing interests.
Further research is needed to explore subtle differences
in treatment response or long-term outcomes between Author contributions
sexes, which could enhance stroke care and optimize
management in the context of a new precision medicine Conceptualization: All authors
era. Data curation: Marco Andrighetti, Paolo Amisano
Writing – original draft: Paolo Amisano
3. Conclusion Writing – review & editing: Marco Andrighetti, Danilo Toni

Revascularization therapies for AIS have shifted from Ethics approval and consent to participate
rigid, time-based criteria to a flexible, tissue viability-
centered approach. This shift prioritizes salvageable tissue Not applicable.
detection over strict time adherence, enabling more Consent for publication
nuanced management strategies.
TNK introduction as an alternative to ALT offers Not applicable.
promising pharmacological reperfusion efficacy across Availability of data
standard and extended windows, potentially reducing
door-to-needle times and simplifying intra- and inter- Not applicable.
hospital transfers for patients eligible for MT. Evidence
from trials also supports intra-arterial thrombolysis Further disclosure
alongside MT, highlighting the fundamental role of Some of the contents of this project have been presented by
microvascular reperfusion to improve AIS outcomes. Prof. Danilo Toni at the Heart Brain and Vessels: Innovazione
Research on posterior circulation strokes, particularly e pratica clinica nelle patologie cardioneurovascolari
the recent ATTENTION and BAOCHE trials, has congress (Aosta, Italy, June 13, 2024).
23
22
improved understanding of basilar artery occlusions, a References
complex subgroup of AIS with variable outcomes and
traditionally lack of strong evidence. 1. Boysen G, ECASS Study Group. European Cooperative
Acute Stroke Study (ECASS): (rt-PA-Thrombolysis in acute
Moreover, expanding MT criteria to include large stroke) study design and progress report. Eur J Neurol.
ischemic cores and DMVOs underscores the value of 1995;1(3):213-219.
endovascular techniques in complex cases. Trials, such as
RESCUE-Japan LIMIT, SELECT-2, ANGEL-ASPECT, doi: 10.1111/j.1468-1331.1995.tb00074.x
26
24
25
TENSION , and TESLA support EVT benefits across 2. Amiri H, Bluhmki E, Bendszus M, et al. European
28
27
diverse patient groups, even without perfusion mismatch. cooperative acute stroke study-4: Extending the time for
thrombolysis in emergency neurological deficits ECASS-4:
These cumulative findings underscore a dynamic, ExTEND. Int J Stroke. 2016;11(2):260-267.
rapidly advancing landscape in AIS management, one that
emphasizes individualized imaging markers, integrates doi: 10.1177/1747493015620805
advanced pharmacological and mechanical strategies, 3. Davis SM, Donnan GA, Parsons MW, et al. Effects of
and broadens revascularization criteria to address diverse alteplase beyond 3 h after stroke in the Echoplanar
stroke presentations. Imaging Thrombolytic Evaluation Trial (EPITHET):
A placebo-controlled randomised trial. Lancet Neurol.
This approach enhances the potential for personalized, 2008;7(4):299-309.
evidence-based stroke care, improving accessibility and
supporting increasingly favorable outcomes for patients doi: 10.1016/S1474-4422(08)70044-9
worldwide. 4. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for
stroke at 6 to 16 hours with selection by perfusion imaging.
Acknowledgments N Engl J Med. 2018;378(8):708-718.
None. doi: 10.1056/NEJMoa1713973

Volume 3 Issue 3 (2025) 9 doi: 10.36922/bh.6683