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Intra-Arterial Therapy for Acute Ischemic Stroke: a Golden Age

  • Critical Care Neurology (K Sheth, Section Editor)
  • Published:
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Opinion statement

With the recent publication of multiple trials demonstrating the superiority of the endovascular treatment of patients presenting with stroke from large vessel occlusion (LVO) over medical management, the emergent care of these patients is entering a new era. This realization justifies an aggressive treatment approach with these stroke patients, given the poor natural history of the disease. In general, treatment should occur as quickly as is reasonably possible. Patients with NIHSS >8 should be considered, and if <6 h from onset imaging selection achieved with CT and CTA. Those with ASPECTS >5, LVO and intermediate or good collaterals should be treated emergently. For patients with clinical deficits presenting in later timeframes MRI should be used to define core infarct size and therefore treatment eligibility. MRI might also be considered for the workup of stroke patients in centers that can offer it rapidly. Recanalization should be attempted with a stentriever or using a direct aspiration technique, with the patient under conscious sedation rather than general anesthesia, if that is a safe option. Angiographically, the goal is reperfusion of mTICI 2b/3. Post-procedure, the patient should be admitted to an intensive care setting and assessed for inpatient rehabilitation placement as soon as stable. Continuous institutional process improvement ensures that optimization of treatment times and logistics is an ongoing endeavor. Finally, patient outcomes should be assessed at three months, most commonly using the modified Rankin score.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Conflict of Interest

Pedro Telles Cougo-Pinto, Ronil V Chandra, Claus Z Simonsen, and Thabele Leslie-Mazwi declare no conflicts of interest. Joshua A Hirsch declares that he holds shares in Intratech Medical, unrelated to the work.

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Authors and Affiliations

  1. J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Pedro Telles Cougo-Pinto MD, MSc

  2. Neuroendovascular Service, Massachusetts General Hospital, Boston, MA, 02114, USA

    Joshua A. Hirsch MD & Thabele Leslie-Mazwi MD

  3. Interventional Neuroradiology, Monash Health, Monash University, Melbourne, Australia

    Ronil V. Chandra MBBS, FRANZCR

  4. Department of Neurology, Stroke, Aarhus University Hospital, Aarhus, Denmark

    Claus Z. Simonsen MD

  5. Department of Neurosciences and Behavior Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil

    Pedro Telles Cougo-Pinto MD, MSc

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  1. Pedro Telles Cougo-Pinto MD, MSc
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  3. Claus Z. Simonsen MD
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  5. Thabele Leslie-Mazwi MD
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Correspondence to Thabele Leslie-Mazwi MD.

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Cougo-Pinto, P.T., Chandra, R.V., Simonsen, C.Z. et al. Intra-Arterial Therapy for Acute Ischemic Stroke: a Golden Age. Curr Treat Options Neurol 17, 30 (2015). https://doi.org/10.1007/s11940-015-0360-7

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