The algorithm of reperfusion treatment of the ischemic stroke: focus on DAWN and DEFUSE-3 trials

Abstract

The history of reperfusion treatment for ischemic stroke was officially recognized in 1996, when the use of systemic thrombolytic therapy (TLT) was authorized in the United States of America and the first clinical guidelines were published (American Heart Association (AHA) Stroke Council). The use of TLT for the treatment of ischemic stroke in the Russian Federation began in 2005–2006. The next step was the development of endovascular reperfusion techniques (2005) following the presentation of the results of the MERCI study, which evaluated the safety and efficacy of microconductors for fragmentation and destruction of blood clots. Currently, neurologists working with patients with acute cerebrovascular accidents are guided by national regulatory documents — order of the Ministry of Health of the Russian Federation dated by November 15, 2012 No. 928n “On approval of the Procedure for providing medical care to patients with acute cerebrovascular accidents” and the Protocol of reperfusion therapy acute ischemic stroke (2019), which provide basic information on the methods of diagnosis and treatment of ischemic cerebral stroke, as well as international recommendations ESO, AHA/ASA, which provide grounds for increasing therapeutic options, in particular by extending the time of the “therapeutic window”. The authors of article created the algorithm for reperfusion therapy for ischemic stroke, based on the analysis and generalization of regulatory documents, clinical guidelines and the results of DAWN and DEFUSE-3 studies.