The endovascular treatment of acute ischemic stroke - a perspective for Republic of Moldova

Abstract

Introduction: The endovascular approach as an elective method of treatment for acute ischemic stroke, gained rapidly its popularity, practical application and legal consent after major international trials. Purpose and objectives: this study represents a review of international clinical trials outcomes containing the up to date and comprehensive recommendations regarding the acute ischemic stroke endovascular treatment.

Methods and materials: Cases of 5 international trials were reviewed in order to accomplish a view, contending the best approach for the patients that fitted: therapeutic window (from 6h to 12h); proximal arterial thrombosis confirmed by angiographic CT; a National Institutes of Health Stroke Scale (NIHSS) evaluation (from 8 up to 29), age 18-80 and the most important reference – used technique: mechanical maneuvers (thrombectomy, thrombaspiration, mechanical rupture, entrapment or the temporary endovascular bypass) versus both thrombolysis (thrombolytic agents with adjunctive therapy) and mechanical actions.

Results: Best outcome were registered for the patients that have been treated both with thrombolysis and using the mechanical approach as well: high scores for Barthel index and great rating for an early reperfusion, CT confirmed.

Conclusion: Involving the data of an increased rate for the acute ischemic stroke, raising by years, in the Republic of Moldova, as well as the abominable long term effect on the patient’s life quality, an endovascular intervention is requested.Considering the speed of development of endovascular neurosurgery, rational premises could be made equally in our republic with the foundation of endovascular specialists, exploiting the full capacity of CT and availability of the essential drugs. Consequently, the education of the population is needed to determine the early symptoms of an ongoing stroke, so on they could fit the therapeutic window for the endovascular engagement, starting with basic thrombolysis, in order to diminish the potential irreversible impact on the patient’s health.