Acute Ischemic Stroke Literature Research DEF

Search through the ischemic stroke literature and identify all papers that report on the use of either a lytic agent (tissue Plasminogen activator (tPA), pro-urokinase, or streptokinase) or a mechanical device (thrombectomy or aspiration device) to treat ischemic stroke patient with large vessel occlusions (LVO’s). We want to correlate the “rate of complete recannalization” from treatment with the “percentage of patients achieving a good outcome” for each lytic drug used and for each device type used. Note: lytic drugs may be used intra venous (IV) or intra-arterial (IA). Please categorise IV and IA separatly even if the same drug is used. “Good outcome” after stroke intervention is defined as a modified rankin score (mRS) of 2 or less. Complete recannalization is defined as TIMI (or TICI) flow of 3. Partial recannalization is TIMI flow of 2. In a stroke context a large vessel is generally defined as an artery whose diameter is greater than 1.5mm and includes the Internal Carotid, Middle Cerebral (M1 and M2 segments), the Anterior Cerebral, the Vertebral and the Basilar arteries. Do not include details of studies focused on small vessel occlusions. The review should include the following important studies: PROACT 2, Merci 1, Multi-Merci, The Penumbra trial, The Significance of LVO’s by Wade Smith, IMS 2. Only studies that report on Recannalization, modified rankin score at 3 (or 4 or 6) months and the rates of symptomatic intra-cerebral hemorrhage (SICH) should be included. The data should be presented on a spreadsheet and should include comprehensive details of the trials for reference with baseline NIHSS, average age, ICH rate, SICH rate highlighted. Where the % partial recannalization is recorded this should be documented but grouped separate from the key measure of Complete Recannalization. Details of each reference should also be included to allow cross checking. A summary of the findings should be included in a word or excel document. A sub analysis should report on patients that achieved full recannalization but did not achieve a good clinical outcome. This sub analysis should categorize/analyse the reasons for poor outcomes in these patients (Examples might include: high % of SICH, high % of patients treated at late time point, high % of vessel dissection, high % of device complications etc.).