Challenges Intraarterial treatment (IAT) with the use of a retrievable stent improves outcome in selected patients with acute ischemic stroke (AIS) and a proximal intracranial artery occlusion. Still, major challenges in the treatment of acute stroke remain. First, about 15% of all strokes are intracerebral hemorrhages (ICH), for which treatment options are very limited. Second, only few patients with AIS eligible for EVT. And third, even after successful intraarterial treatment, in active treatment arms of recent IAT trials one to two thirds of patients still had a poor outcome. Incomplete microvascular reperfusion despite recanalization of the occluded artery is a major contributor to poor outcome after AIS. Possible mechanisms are distal microembolization and distal microthrombotic occlusion through activation of platelets and pro-coagulatory pathways and possibly also through microvascular occlusion through cellular swelling by activation of the innate and adaptive arms of the immune system.
Translational research Apart from providing direct answers to pressing clinical questions, the trials will provide a wealth of prognostic and etiologic information. The trials will have similar designs and data structure. Biomarker information from serial blood samples, neuro-imaging and thrombus material will be gathered and stored centrally.
we apply discrete event modelling (DES) with data from the trials, to optimize stroke care.