Abstract
During the last few months, seven pivotal papers have been published in renowned medical journals that have demonstrated the superiority of endovascular therapy added to intravenous tPA in patients with acute ischemic stroke and proximal vessel occlusion. This evidence poses a therapeutic challenge for Colombian neurologists and their patients, given the already suboptimal care for acute stroke patients in Colombia. This critical review comprises the studies MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE and THERAPY. Also, the current 2015 AHA/ASA guidelines on endovascular therapy for acute ischemic stroke were included. Their results reinforce the need to provide IV tPA to all eligible patients while, at the same time, adding diagnostic tools such as CTA (CT angiography) and/or MRA (MR angiography) to present hyperacute treatment protocols in order to confirm or rule out the presence of proximal vessel occlusion. The main challenges ahead lie in closing the existent gaps in stroke care between public and private hospitals, providing public hospitals with modern technologies and trained medical personnel as required for the optimal performance of neuroendovascular therapy, all of them comprised within a national stroke network.
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