March 2022 | Issue 45
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Featured in this issue:
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Radial access Is it here to stay?
Thrombectomy shown to restore more function than medication alone following severe stroke A new study from Japan has produced randomised controlled trial (RCT) evidence demonstrating the effectiveness of mechanical thrombectomy procedures, or endovascular therapy (EVT), alongside standard medical care in restoring function for patients who have suffered a severe ischaemic stroke due to extensive cerebral infarction. These late-breaking data— which also showed an increased occurrence of intracranial haemorrhage (ICH) among patients who underwent EVT—were presented at the International Stroke Conference (ISC 2022; 9–11 February, New Orleans, USA) and have since been published in the New England Journal of Medicine.
T
Profile Michael Chen
he respective senior and lead authors of this research, Takeshi Morimoto and Shinichi Yoshimura (Hyogo College of Medicine, Nishinomiya, Japan), told NeuroNews that their results offer evidence in favour of EVT for patients with extensive cerebral infarction in Japan—and may help to establish more global evidence when combined with findings from other, similar studies currently underway. “Of course, there are limitations, such as the effect of race and the fact that the imaging evaluation method used in the majority of patients was MRI [magnetic resonance imaging],” they added, “but we believe it is significant that the results of a high-quality RCT showed the effectiveness of EVT in extensive cerebral infarction.” And, moving on to discuss future directions for research in this space, they said: “We think it is important to estimate the number of patients and set the endpoints based on the
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EVT group:
Ability to walk without assistance/none-tomoderate residual disability 90 days
31%
Major, early neurological improvement 48 hrs
31%
Intracranial haemorrhage 48 hrs
58%
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Standard care group:
Ability to walk without assistance/none-tomoderate residual disability 90 days
13%
Major, early neurological improvement 48 hrs
9%
Intracranial haemorrhage 48 hrs
31%
quality registry, and then set up an RCT study plan using these estimates. This study was conducted only in Japan—and we believe that we should now aim for generalisation by recruiting patients throughout Asia and the rest of the world.”
EVT for severe stroke patients
In 2018, the American Heart Association (AHA) updated its stroke treatment guidelines to recommend EVT—involving mechanical clot removal via a thrombectomy—for select stroke patients, with a view to improving their odds of functional recovery. According to the AHA, effectiveness of the approach had previously been established in patients whose large-vessel clots disrupted blood flow to fewer areas of the brain. However, prior clinical evidence was mixed regarding patients with more severe strokes whereby a clot in one or more large brain arteries interrupts blood flow to a greater area of the brain. “I have often encountered a dramatic improvement in a patient just after the mechanical clot removal procedure, even when the infarction area was large,” said Yoshimura. Continued on page 2
Let’s go beyond. Together, we can break new ground in neurovascular care.
Marc Russo The bright future of neuromodulation
NeuroMODULATION
Late-breaking data presented at NANS 2022
Physicians from across the globe gathered at the recent North American Neuromodulation Society (NANS) annual meeting (13–15 January 2022; Orlando, USA) to hear multiple key pieces of research in neuromodulation and pain medicine presented for the first time. DATA FROM LARGE CLINICAL trials assessing high-frequency spinal cord stimulation (SCS) for painful diabetic neuropathy and non-surgical refractory back pain were disclosed by Erika Petersen (Little Rock, USA) and Leonardo Kapural (Winston-Salem, USA), respectively. Elsewhere, Guilherme Santos Piedade (Düsseldorf, Germany) offered new findings relating to optimising outcomes with dorsal root ganglion stimulation, while a novel approach using multiple-modality SCS therapy for chronic pain was presented by Mark Wallace (San Diego, USA). Several plenary sessions across the three-day conference saw pressing issues in neuromodulation—including the topic of telehealth, discussed by Vwaire Orhurhu (Williamsport, USA)—feature prominently as well. To read coverage of these NANS 2022 highlights, and much more from the world of neuromodulation, turn to page 21.
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