The Evolution of Technology
Reads0
Chats0
TLDR
The historical development of technologies for catheter-based reperfusion of the acutely ischemic human brain is brief but eventful (Table), and the most effective and commonly used mechanical treatment strategies vary regionally across the globe.Abstract:
The historical development of technologies for catheter-based reperfusion of the acutely ischemic human brain is brief but eventful (Table). The first clinical patients were treated with local microcatheter delivery of intra-arterial fibrinolytics in the mid-1990s. The first mechanical recanalization technique, primary intra-arterial balloon angioplasty, was described a few years later. Over the subsequent decade and a half, successive waves of innovative mechanical thrombectomy devices were introduced. The rapid proliferation of technology reflects the inherent dynamic of biomechanical device development, characterized by rapid engineering innovation focused on a well-circumscribed target, in contrast to the slower, more deliberate arc of drug development, which requires extensive testing of each new molecular entity for unexpected off-target effects on diverse organs.
The heterogeneity of target vascular lesions in cerebrovascular disease mandates a diversity of mechanical treatment options for deployment by interventionalists. In many patients, the intracranial occlusion is an embolus that has arisen from the heart or a proximal aortocervical arterial source and landed in a relatively normal recipient artery. Such target thrombi respond well to retrieval and aspiration strategies. In other patients, the occlusive lesion is comprised of an in situ intracranial atherosclerotic plaque with supervening thrombosis. These target lesions will not respond well to retrieval devices, which catch on the plaque, or to aspiration devices, which are effective only for the thrombus component. However, they do respond well to angioplasty and stenting, which accomplish controlled cracking and dissection of the underlying atherosclerotic lesions.1 There is a notable race, ethnic variation in the composition of intracranial occlusions.2 Among whites, emboli from the heart or extracranial arterial sources are common; among Asians and blacks, in situ intracranial atherosclerosis with supervening thrombosis is more frequent. As a result, the most effective and commonly used mechanical treatment strategies vary regionally across the globe.
The endovascular …read more
Citations
More filters
Journal ArticleDOI
The cultural niche: Why social learning is essential for human adaptation
TL;DR: It is argued that humans may be smarter than other creatures, but none of us is nearly smart enough to acquire all of the information necessary to survive in any single habitat.
Journal ArticleDOI
Tackling Grand Challenges Pragmatically: Robust Action Revisited
TL;DR: A novel approach to addressing the world’s grand challenges based on the philosophical tradition of American pragmatism and the sociological concept of robust action is theorized, and three robust strategies that organizations can employ in tackling issues such as climate change and poverty alleviation are identified.
Book
The Shock of the Old: Technology and Global History since 1900
TL;DR: The first proper global account of the place of technology in twentieth century history, "The Shock of the Old" as mentioned in this paper, is based on a different idea that for the full picture of the history of technology we need to know not about what a few people invented, but about what everyday people used - and when they actually used things, if it was a long time after invention.
Journal ArticleDOI
Identification of the Social and Cognitive Processes Underlying Human Cumulative Culture
TL;DR: The success of the children, but not of the chimpanzees or capuchins, in reaching higher-level solutions was strongly associated with a package of sociocognitive processes—including teaching through verbal instruction, imitation, and prosociality—that were observed only in the children and covaried with performance.
Journal ArticleDOI
Ties That Last: Tie Formation and Persistence in Research Collaborations over Time
TL;DR: Using a longitudinal dataset of research collaborations over 15 years at Stanford University, the authors built a theory of intraorganizational task relationships that distinguishes the different factors as different factors in different tasks.
References
More filters
Journal ArticleDOI
Intra-arterial Prourokinase for Acute Ischemic Stroke: The PROACT II Study: A Randomized Controlled Trial
Anthony J. Furlan,Randall T. Higashida,Lawrence R. Wechsler,Michael Gent,Howard A. Rowley,Carlos S. Kase,Michael S. Pessin,Arvind Ahuja,Fred Callahan,Wayne M. Clark,Frank L. Silver,Frank Rivera +11 more
TL;DR: Despite an increased frequency of early symptomatic intracranial hemorrhage, treatment with IA r-proUK within 6 hours of the onset of acute ischemic stroke caused by MCA occlusion significantly improved clinical outcome at 90 days.
Journal ArticleDOI
The Impact of Recanalization on Ischemic Stroke Outcome A Meta-Analysis
Joung-Ho Rha,Jeffrey L. Saver +1 more
TL;DR: Recanalization is strongly associated with improved functional outcomes and reduced mortality and is an appropriate biomarker of therapeutic activity in early phase trials of thrombolytic treatment in acute ischemic stroke.
Journal ArticleDOI
Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial
Wade S. Smith,Gene Sung,Jeffrey L. Saver,Ronald F. Budzik,Gary Duckwiler,David S Liebeskind,Helmi L. Lutsep,Marilyn M. Rymer,Randall T. Higashida,Sidney Starkman,Y. Pierre Gobin +10 more
TL;DR: Higher rates of recanalization were associated with a newer generation thrombectomy device compared with first-generation devices, but these differences did not achieve statistical significance.
Journal ArticleDOI
Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial
Jeffrey L. Saver,Reza Jahan,Elad I. Levy,Tudor G Jovin,Blaise Baxter,Raul G Nogueira,Wayne M. Clark,Ronald F. Budzik,Osama O. Zaidat +8 more
TL;DR: The Solitaire Flow Restoration Device achieved substantially better angiographic, safety, and clinical outcomes than did the Merci Retrieval System and might be a future treatment of choice for endovascular recanalisation in acute ischaemic stroke.
Journal ArticleDOI
Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial
Raul G. Nogueira,Helmi L. Lutsep,Rishi Gupta,Tudor G Jovin,Gregory W. Albers,Gary Walker,David S Liebeskind,Wade S. Smith +7 more
TL;DR: Patients who have had large vessel occlusion strokes but are ineligible for (or refractory to) intravenous tissue plasminogen activator should be treated with the Trevo Retriever in preference to the Merci retriever.
Related Papers (5)
Intracranial Atherosclerotic Disease; Current Options for Surgical or Medical Treatment
Pil-Woo Huh,Do Sung Yoo +1 more