Trailblazers: hemicraniectomy in ischemic stroke for older patients – the DESTINY II trial
Jüttler E, Unterberg A, Woitzik J, Bösel J, Amiri H, Sakowitz OW, et al. Hemicraniectomy in Older Patients with Extensive Middle-Cerebral-Artery Stroke. N Engl J Med. 2014 Mar 20;370(12):1091–100. Introduction Massive hemispheric involvement occurs in up to 10% of patients with supratentorial infarcts (1). Life-threatening cerebral edema often follows, referred to as malignant middle-cerebral-artery syndrome (2), with…
Trailblazers: Mechanical thrombectomy at 6–24 hours after stroke – the DAWN trial
Introduction Endovascular therapy for acute ischemic stroke was investigated more than two decades ago, especially among patients with large or more proximal occlusion. Conventional intravenous thrombolysis among patients with large, proximal occlusions may not be efficacious and carries the risk of fatal intracranial hemorrhage. The PROACT trials of the late 1990s evaluated the use of…
Trailblazers: Extended time window for thrombolysis in stroke – the ECASS III trial
Introduction Acute ischemic stroke remains one of the few neurological disorders in which expeditious diagnosis and treatment could potentially lead to complete recovery. In 1995, the National Institute of Neurological Disorders and Stroke (NINDS) study group published their landmark randomized controlled trial (RCT) of intravenous thrombolysis with alteplase compared to placebo in acute…
Trailblazers: On-site Fibrinolysis vs. Transfer for angioplasty in STEMI – The DANAMI II Trial
Andersen HR, Nielsen TT, Rasmussen K, et al. The DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. doi: 10.1056/NEJMoa025142. PMID: 12930925. Introduction In September 1977, a 38-year-old man presented to the University Hospital in Zurich, Switzerland, with myocardial infarction. The likely culprit…
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