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Current Endovascular Approach to the Management of Acute Ischemic Stroke

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
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Abstract

Purpose of Review

The review provides an overview of current endovascular management of patients with acute ischemic stroke in the light of recent landmark trials proving unequivocal benefit of the intervention.

Recent Findings

Several randomized trials looking at selective groups of patients presenting after an acute ischemic stroke due to large vessel occlusion in the anterior circulation demonstrated an overwhelming benefit of the endovascular treatment compared to intravenous thrombolysis, leading to expedited changes in the American Heart Association/American Stroke Association guidelines. Nonetheless, there are a relative large number of patients that were not included in those trials that might still benefit from endovascular treatment (acute posterior circulation-related strokes or acute embolic occlusion of middle cerebral artery beyond the main trunk for instances) and in which further studies are needed. We also briefly discuss endovascular techniques, post-procedure care, and endovascular treatment delivery models to expedite stroke patient assessment and rapid transport using updated and improved workflow protocols to provide timely recanalization.

Summary

Endovascular treatment of acute occlusion of a proximal large artery in the anterior circulation is currently the standard of care. Time and quality of recanalization are the most important variables that determine the outcome. The indication for endovascular therapy in different scenarios (acute embolic occlusion in the posterior circulation or more distal branch occlusions) has to be individualized according to each patient’s particular characteristics until new evidence is provided.

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Authors and Affiliations

  1. Department of Neurology, Texas Tech University of Health Sciences Center, 4800 Alberta Avenue, El Paso, TX, 79905, USA

    Rakesh Khatri, Anantha R. Vellipuram, Alberto Maud, Salvador Cruz-Flores & Gustavo J. Rodriguez

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  1. Rakesh Khatri
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  2. Anantha R. Vellipuram
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Correspondence to Rakesh Khatri.

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Rakesh Khatri, Anantha R. Vellipuram, Alberto Maud, and Gustavo J. Rodriguez declare that they have no conflict of interest.

Salvador Cruz-Flores declares that he is a consultant for Novo Nordisk, Lilly, and Sunovion as clinical event adjudicator.

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This article is part of the Topical Collection on Ischemic Heart Disease

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Khatri, R., Vellipuram, A.R., Maud, A. et al. Current Endovascular Approach to the Management of Acute Ischemic Stroke. Curr Cardiol Rep 20, 46 (2018). https://doi.org/10.1007/s11886-018-0989-4

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