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Keywords

efficacy, improved patient outcomes, neuroendovascular procedures, neuroendovascular treatments, poststroke

 

Authors

  1. Holmes, Timbolin D.

Abstract

ABSTRACT: Stroke is the second most common cause of death in women and African Americans, the fourth leading cause of death in Caucasians, and the fifth leading cause of death in men in the United States (Towfighi, Ovbiagele, & Saver, 2010). In addition, stroke costs the nation greater than $57 billion dollars annually through its direct and indirect costs. For example, in the year 2009 alone, the estimated expenditure on the cost of stroke for hospitalization, rehabilitation, and institutionalization was $68.9 billion. Fortunately, there are many treatment strategies available to individuals who had a stroke if they meet certain clinical and time criteria as well as being geographically located in a region where these treatments are available, such as nationally certified stroke centers. Specifically, intravenous and intra-arterial recombinant tissue plasminogen activator (rtPA) and mechanical thrombolysis are used for acute ischemic stroke, whereas treatments for acute hemorrhagic stroke resulting from subarachnoid hemorrhage secondary to ruptured cerebral aneurysm include both endovascular coiling as well as surgical clipping. However, patient outcomes from some of these treatments are controversial. First, it appears that, although revascularization post mechanical thrombectomy has high success rates, patient clinical and neurological outcomes as evidenced by low modified Rankin Scale scores are not as favorable when compared with intravenous or intra-arterial thombolysis. However, endovascular coiling for ruptured cerebral aneurysms resulting in subarachnoid hemorrhage appears to be superior to aneurysm clipping in both clinical and neurological outcomes. Future studies need to focus on making subject pools more homogeneous as well as using standardized outcome measures to facilitate external validation of their results.