Introduction
Endovascular therapy (EVT) has revolutionized the management of acute ischemic stroke, particularly in cases where large vessel occlusions occur. In recent years, multiple endovascular stroke trials have demonstrated the efficacy of EVT in achieving reperfusion and improving functional outcomes in patients with ischemic stroke. One area of interest has been the impact of EVT on internal carotid artery (ICA) occlusions, which can be particularly challenging due to the critical role of the ICA in supplying blood to the brain. This article aims to explore the treatment effect of EVT on functional outcomes in patients with ICA occlusions, with a focus on the results from Hermes, a prominent trial in the field of endovascular therapy for stroke.
Endovascular Therapy Hermes Results
The Hermes trial was a landmark study that sought to evaluate the efficacy of EVT in patients with acute ischemic stroke caused by large vessel occlusions, including ICA occlusions. The trial enrolled a cohort of patients with confirmed ICA occlusions and randomized them to receive either standard medical therapy alone or EVT in addition to medical therapy. The primary outcome measure of the study was functional independence at 90 days, as assessed by the modified Rankin Scale (mRS).
The results of the Hermes trial revealed a significant treatment effect of EVT on functional outcomes in patients with ICA occlusions. Patients who underwent EVT were more likely to achieve functional independence at 90 days compared to those who received medical therapy alone. This improvement in functional outcomes was attributed to the high rate of successful reperfusion achieved through EVT, which allowed for restoration of blood flow to the affected areas of the brain.
Furthermore, the Hermes trial also demonstrated the safety and feasibility of performing EVT in patients with ICA occlusions. Despite the challenges posed by the location and extent of the occlusion, the study found that EVT could be effectively and safely performed in this patient population, with low rates of procedural complications and favorable clinical outcomes.
Endovascular Therapy in Hermes
The Hermes trial highlighted the potential benefits of EVT in patients with ICA occlusions, but it also raised important considerations regarding patient selection, treatment protocols, and outcomes assessment. One key aspect of EVT in ICA occlusions is the need for rapid and accurate diagnosis to identify eligible patients and initiate treatment promptly. Advanced imaging techniques, such as CT angiography and perfusion imaging, play a crucial role in identifying patients with ICA occlusions who are likely to benefit from EVT.
In addition, the Hermes trial underscored the importance of a multidisciplinary approach to the management of patients with ICA occlusions. Collaboration between neurologists, interventional radiologists, neurosurgeons, and other specialists is essential to ensure that patients receive timely and appropriate treatment, optimize procedural outcomes, and provide comprehensive post-procedural care.
Moreover, the Hermes trial highlighted the need for standardized outcome measures and follow-up protocols to assess the long-term impact of EVT in patients with ICA occlusions. Functional independence, quality of life, and cognitive function are important aspects of recovery that should be evaluated in a systematic and comprehensive manner to determine the overall effectiveness of EVT in this patient population.
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