| 1. |
- Ahmed, Niaz, et al.
(författare)
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Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018.
- 2019
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Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 4:4, s. 307-317
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the European Stroke Organisation-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year's European Stroke Organisation-Karolinska Stroke Update Meeting was held in Stockholm on 11-13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and at www.eso-karolinska.org and http://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.
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| 2. |
- Falk-Delgado, Anna, et al.
(författare)
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Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke : a meta-analysis
- 2016
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Ingår i: Journal of neurointerventional surgery. - : BMJ. - 1759-8486 .- 1759-8478. ; 8:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Intravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone.METHODS: Databases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I(2) (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.RESULTS: Six studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group.CONCLUSIONS: Endovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone.
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| 3. |
- Kuntze Söderqvist, Åsa
(författare)
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Mechanical thrombectomy for acute ischemic stroke
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this doctoral thesis was to study the outcome and safety of mechanical thrombectomy, which is an endovascular technique for treating moderate to severe acute ischemic stroke caused by a large cerebral artery occlusion. The technique has been developed over the last two decades. At the onset of this doctoral project, only a limited numbers of studies on the technique had been published, but the results were very promising. This thesis is based on five peer-reviewed publications. In these studies, it was found that: • patients with basilar artery occlusions who were treated using mechanical thrombectomy (at Karolinska University Hospital between September 2005 – November 2010), had a significantly better functional outcome compared to patients in other studies, where intravenous thrombolysis or no reperfusion therapy was given (Study I). • mechanical thrombectomy was a safe and effective method for restoring blood flow in selected patients suffering from a moderate to severe acute ischemic stroke that was caused by a large artery occlusion (Study II). This was concluded from an examination of patients with anterior and posterior circulation strokes who were treated with mechanical thrombectomy at Karolinska University Hospital between September 2005 – December 2011. • neither prior treatment with intravenous thrombolysis, nor advanced age, was significantly associated with a risk of symptomatic intracranial hemorrhage (Study II). • functional outcome three months after mechanical thrombectomy was equally good for those over 80 years of age as for those between 50-64 and 65-79 years of age (Study III). This was concluded from an examination of the subgroup of patients from study II with anterior circulation stroke, selected according to practice at Karolinska University Hospital. • in patients with wake-up stroke, there was no indication of poorer outcome (Study III). • endovascular treatment combined with intravenous thrombolysis led to a higher ratio of patients with improved functional outcome compared to patients treated with intravenous thrombolysis alone, with an absolute risk reduction of 19% (Study IV). This was concluded from a meta-analysis of six randomized controlled trials. • the estimated rate of thrombectomy in Sweden in 2013 might have been more than five times higher than the actual rate, if patients had been selected according to our practice at the Karolinska University Hospital (a practice similar to the recently published updated treatment recommendations from both European and American organisations) (Study V). This was concluded by comparing treatment proportions at our institution by level of stroke severity with stroke data from the rest of Sweden, provided from Riksstroke (the Swedish national stroke registry). In conclusion, it has been shown that mechanical thrombectomy is a safe treatment, which significantly improves the likelihood of functional outcome for patients with moderate to severe stroke. The findings indicate that a substantial increase in demand for this treatment option should be expected. The main challenge now is to fully implement the technique in clinical practice and to be able to offer it to all patients throughout Sweden, not just to those who live in the proximity of a university hospital.
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