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Endovascular Thrombectomy for Acute Ischemic Stroke

  • Stroke (JF Meschia, Section Editor)
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Abstract

Purpose of Review

To review the current evidence supporting the use of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).

Recent Findings

Recent advances in AIS management by EVT have led to significant reduction in morbidity and mortality in selected patients with LVO within the anterior circulation. Until recently, use of EVT was strictly based on time criteria, within 4.5 to 12 h of symptom onset with many patients presenting with “wake-up” stroke who were not considered for EVT. The positive results of the DAWN and DEFUSE-3 trials have shown benefit in extending the therapeutic window for EVT to 24 and 16 h, respectively, after last known normal (LKN) time in the setting of large ischemic penumbra. These trials represent a paradigm shift in contemporary treatment of AIS, changing from a purely time-based decision to treat to an individualized decision based on clinical and radiographic findings of salvageable tissue.

Summary

Overall, acute stroke management has evolved considerably over the years from intravenous thrombolysis to include EVT, with paralleled improvements in patient selection and thrombectomy devices. Since the results of the DAWN and DEFUSE-3, EVT is now considered the standard of care in select patients with anterior circulation LVO up to 24 h from LKN time. Despite these developments, post-stroke disability remains pervasive and further studies are warranted in establishing the role of EVT in posterior circulation and distal vessel occlusions, with need for development of new and effective techniques for revascularization of small vessels.

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Authors and Affiliations

  1. Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport, LA, USA

    Tasneem F. Hasan

  2. Department of Neurologic Surgery, Medical College of Georgia, Augusta, Georgia

    Nathaniel Todnem

  3. Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Neethu Gopal, Sukhwinder S. Sandhu & Rabih G. Tawk

  4. Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL, USA

    David A. Miller

  5. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    Josephine F. Huang

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  1. Tasneem F. Hasan
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Tasneem F. Hasan, Nathaniel Todnem, Neethu Gopal, David A. Miller, Sukhwinder S. Sandhu, Josephine F. Huang, and Rabih G. Tawk declare that they have no conflict of interest.

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Hasan, T.F., Todnem, N., Gopal, N. et al. Endovascular Thrombectomy for Acute Ischemic Stroke. Curr Cardiol Rep 21, 112 (2019). https://doi.org/10.1007/s11886-019-1217-6

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