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Endovascular Treatment of Acute Ischemic Stroke

  • Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Endovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke.

Recent findings

The indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6–24 h after last-known-well, and improved device and operator proficiency allowing treatment of M2-MCA occlusions and tandem occlusions. Further inclusion of paediatric patients and patients with larger infarct core or milder stroke symptoms for ET has been proposed; however, this remains unproven. This growing applicability is supported by more efficient systems of care, employing modern techniques such as telemedicine, mobile stroke units and helicopter medical services. Ongoing debate exists regarding thrombolytic agent, thrombectomy technique, anaesthesia method and the role of advanced neuroimaging, with upcoming RCTs expected to provide clarification.

Summary

The journey to further improving the efficacy of ET has advanced and diversified rapidly over recent years, involving improved patient selection, increased utility of advanced neuroimaging and ongoing device redevelopment, within the setting of more efficient, streamlined systems of care. This dynamic and ongoing influx of evidence-based refinements is key to further optimising outcomes for ELVO patients.

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Notes

  1. Stryker, Kalamazoo, MI, USA

  2. Penumbra Inc., Alameda, CA, USA

  3. Medtronic Neurovascular, MN, USA

  4. Stryker

  5. Both Penumbra, Alameda, California

References and Recommended Reading

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Authors and Affiliations

  1. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia

    Julian Maingard BBiomedSci, MBBS &  Ronil V Chandra MBBS, MMed, FRANZCR, CCINR

  2. School of Medicine, Deakin University, Geelong, Victoria, Australia

    Julian Maingard BBiomedSci, MBBS

  3. Department of Radiology, Austin Health, Heidelberg, Victoria, Australia

    Michelle Foo MBBS(Hons)

  4. Faculty of Medicine, Nursing and Heath Sciences, Monash University, Clayton, Victoria, Australia

    Ronil V Chandra MBBS, MMed, FRANZCR, CCINR

  5. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Thabele M Leslie-Mazwi MD

  6. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA

    Thabele M Leslie-Mazwi MD

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Maingard, J., Foo, M., Chandra, R.V. et al. Endovascular Treatment of Acute Ischemic Stroke. Curr Treat Options Cardio Med 21, 89 (2019). https://doi.org/10.1007/s11936-019-0781-9

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