Trombektomi vid akut ischemisk stroke Kunskapsläget 2014 SBU-Rapport

Endovaskulär behandling vid akut ischemisk stroke Intraarteriell trombolys (< 4,5 h) Trombektomi (< 6 h) –Första generationen (MERCI, PENUMBRA) –Andra generationen (SOLITAIRE, TREVO)

SoS / ESO SoS 2008 –FoU ESO 2013 (proposed) –Mechanical thrombectomy achieves higher recanalization rates compared to historical controls with or without intravenous rt-PA. Reported recanalization rates vary between studies (Grade B, Level 2). –In general, the odds for favourable outcome are significantly increased with early vessel recanalization. If indicated, then mechanical thrombectomy should be performed as soon as possible after its indication (Grade B, Level 2). –The Merci, Penumbra System, Solitaire FR, and Trevo thrombectomy devices can be useful in achieving recanalization alone or in combination with pharmacological fibrinolysis in carefully selected patients (Class IIa; Level of Evidence B).

AHA / ASA 2013 The Merci, Penumbra System, Solitaire FR, and Trevo thrombectomy devices can be useful in achieving recanalization alone or in combination with pharmacological fibrinolysis in carefully selected patients (Class IIa; Level of Evidence B). Intra-arterial fibrinolysis or mechanical thrombectomy is reasonable in patients who have contraindications to the use of intravenous fibrinolysis (Class IIa; Level of Evidence C). Rescue intra-arterial fibrinolysis or mechanical thrombectomy may be reasonable approaches to recanalization in patients with large-artery occlusion who have not responded to intravenous fibrinolysis. Additional randomized trial data are needed (Class IIb; Level of Evidence B).

SBU-rapport oktober 2013 Kommenterar 3 studier som publicerats under 2013 –SYNTHESIS –IMS-3 –MR Rescue Sammanfattningsvis förändrar inte dessa studier evidensläget. –Negativa resultat –Utvärderar endast äldre metoder –…

Lokala riktlinjer 2012 Screena alla strokepatienter =10 Vid ocklusioner på CT-angiografi tas kontakt med Lund för diskussion. –Rescuebehandling vid hotande utbredd stroke där intravenös behandling befaras otillräcklig –Primärbehandling vid kontraindikation mot intravenös trombolys

Genomförda behandlingar i Kronoberg Därutöver ett mindre antal som transporterats till Lund men där behandling ej blivit genomförd.

Praktiska förutsättningar Ej tillgängligt på CLV / LL Begränsad tillgänglighet i Lund –Tidigare fyra operatörer – nu en. –Måndag till fredag 8-20, helger 8-18 Linköping Göteborg Köpenhamn

Lokala riktlinjer 2014