Neurovascular Intervention Coil Market report , discusses various factors driving or restraining the market, which will help the future market to grow with promising CAGR. The Neurovascular Intervention Coil Market research Reports offers an extensive collection of reports on different markets covering crucial details. The report studies the competitive environment of the Neurovascular Intervention Coil Market is based on company profiles and their efforts on increasing product value and production. This report also covers all the regions and countries of the world, which shows a regional development status, including market size, volume and value, as well as price data.
The report analyzes the market of Neurovascular Intervention Coil by main manufactures and geographic regions. The report includes Neurovascular Intervention Coil definitions, classifications, applications, and industry chain structure, development trends, competitive landscape analysis, and key regions development and market status. The trial was aborted early because of futility. Apart from that IV rt-PA was compared with isolated endovascular treatment and that too was mostly IA rt-PA, while new generation devices were used in very small numbers of patients [ 19 ].
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A detailed discussion of the reasons for the lack of efficiency of the clot retrieval devices in these trials and weaknesses of each trial design is beyond the scope of this review article. However, the main limitations of these trials were 1 lack of using pretreatment imaging modalities to evaluate the salvageable brain as reperfusion into irreversibly damaged ischemic region is not beneficial and also to identify the location of occlusion, 2 treatment with early generation clot retrieval devices, 3 recruitment of small numbers of patients per center, 4 comparison of IV rt-PA to the endovascular treatment alone SYNTHESIS , 5 time lag between hospital presentation and treatment.
The results of these trials were published in ; despite the visible limitations and weaknesses, the failure of these three trials in establishing the clinical impact of clot retrieval devices was a blow to the years of efforts of achieving better outcomes in patients with acute ischemic stroke. However, criticism of these trials laid the foundation for newer trials with robust study designs using new generation clot retrieval devices.
A self-expanding stent retriever is deployed in the occluded vessel within the thrombus; the device entraps the thrombus within its struts and is then withdrawn back into the delivery catheter. The Solitaire flow restoration device was the first one to get FDA clearance under this category [ 17 ]. Comparison of the results of initial clinical trials deploying different types of clot retrieval devices.
The decision was based on the results of a clinical trial which showed better day functional outcome in the group of patients managed with both rt-PA and TREVO as compared to the ones who did not receive TREVO [ 25 ].
Trends in Neurovascular Interventions
This is the biggest milestone in the journey of clot retrieval devices achieved until now as previously these devices were only indicated for patients who could not receive rt-PA or for those patients who did not respond to rt-PA therapy. This would definitely help in further reducing the disabilities like paralysis and impaired speech associated with acute ischemic stroke. The device is deigned to trap the clot with minimal compression, rapidly deliver the Thrombolysis in Cerebral Infarction scale of 2b-3 TICI 2b-3 reperfusion, and retain the clot during retrieval, protecting against embolization [ 22 ].
Optimal positioning to the occlusion is facilitated by radiopaque markers.
In , Neuravi, a company based in Galway Ireland, announced completion of enrollment in an international clinical trial assessing the effectiveness and safety of this device. This study enrolled patients in 19 sites across Europe and USA. Since then, IV rt-PA has been the gold standard in the management of acute ischemic stroke. Hacke et al. Emberson et al.
Although the current guideline suggests administering of IV rt-PA within 4. Furthermore, IV rt-PA is less effective in cases of large vessel occlusion [ 5 , 14 ]. However, this could be improved when combined with endovascular clot retrieval devices. Rodrigues et al. It was evident from these trials that the use of newer generation clot retrieval devices, robust pretreatment imaging selection criteria, and better work flow resulted in favorable functional outcome in patients with acute ischemic stroke due to proximal occlusion of large vessels in anterior circulation [ 29 ].
Goyal et al. Out of these patients, patients were allocated to the endovascular thrombectomy while patients were assigned to the control group. Furthermore, better functional outcome using the newer generation clot retrieval devices, mainly the stent retrievers, was seen across a wide range of age, initial stroke severity, and also in the patients ineligible for the gold standard IV rt-PA treatment.
Hence, this meta-analysis supports the notion of not restricting the endovascular mechanical thrombectomy treatment on the basis of age, severity of the disease, and ineligibility for IV rt-PA treatment [ 29 ]. Overview of the five positive randomized clinical trials that showed the efficacy of clot retrieval devices. The results of these five clinical trials have definitely revolutionized the management of acute ischemic stroke.
Choi et al.
Now effort needs to be done to make it standard of care by reshaping the emergency stroke care globally so that the majority of patients get benefit from these innovative endovascular clot retrieval devices. Interventional cardiology is a rapidly evolving clinical field with constant need for interventional cardiologists to up-skill to be able to use novel devices and techniques for cardiovascular diseases for better patient outcomes.
This is particularly evident through advances in structural heart disease interventions such as transcatheter aortic, mitral, and now tricuspid valve interventions. In parallel, interventional cardiologists are using novel medical devices for the treatment and monitoring of heart failure, atrial fibrillation, left atrial appendage closure, hypertension, etc. There is now evidence to treat acute stroke with embolectomy and thrombus aspiration. This is ideally performed by highly trained neurointerventionists through minimally invasive intracranial techniques. To provide a round the clock h clinical service for any interventional procedure requires a significant number of trained interventionalists.
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At present there are only a few hundred trained interventional neurologists in comparison to thousands of interventional cardiologists in most countries. The number of interventional procedures performed in cardiology is much higher than neurology, and training of a large number of interventional neurologists for a small number of elective cases cannot be justified. In addition, the acute coronary syndrome programmes for primary PCI are well established with significant infrastructures in place for speedy patient transportation road and air ambulance and activation of cardiac catheterization laboratories.
Most cardiac catheterization laboratories are equipped with essential hardware and software required for intracranial procedures. Studies have shown the safety and efficacy of the endovascular mechanical thrombectomy procedures performed by interventional cardiologists [ 31 , 32 ]. Finally interventional cardiologists are very familiar with antiplatelet and anticoagulation therapies for patients with acute coronary syndrome ACS and stroke risk.
In our opinion, the training of interventional cardiologists for acute stroke intervention is appropriate and will utilize the existing emergent endovascular care infrastructure with significant costs savings to the already economically burdened heath care system.
No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. Enhanced content. National Center for Biotechnology Information , U. Journal List Cardiol Ther v. Cardiol Ther. Published online Jul Author information Article notes Copyright and License information Disclaimer.
Haroon Zafar, Email: ei.
Corresponding author. Received Jun This article has been cited by other articles in PMC. Neurovascular intervention is the use of minimally invasive medical devices and techniques to treat vascular diseases of central nervous system. Neurovascular interventional procedures help to avoid surgeries of high risk zones of body such as brain, spine, or the neck. It is a field with significant scope for research and development because it requires a highly expertise neurologist to perform the procedures with current conventional devices.
There is a need to advance technology and devices to minimize the failures in interventional procedures. Neurovascular Intervention involves usage of minimally invasive approaches including the use of microcatheters to treat various diseases of the brain, head, neck, and spine. Neurovascular interventional devices are used in procedures such as removal of blood clot within a blood vessel in the brain during an acute ischemic stroke and to restore blood flow. Several improvements are noted with endovascular treatment of intracranial aneurisms by detachable coils.
The market is driven by advancements that are able to address the unmet needs of a large population suffering from cerebrovascular diseases across the world. According to the World Health Organization, incidence of cerebrovascular diseases such as migraine and stroke is high in Italy.