Neuro-Interventional Management of a Stroke

Abstract

Each year almost 800,000 people suffer a new or recurrent stroke. Ischemic strokes are most commonly caused by either a rupture of an atherosclerotic plaque or by a blood clot that forms in another part of the body and travels into the brain. Ischemic strokes can occur suddenly and can lead to devastating consequences. Timely recognition and response is critical. Currently, the only FDA approved treatment for ischemic strokes is the administration of intravenous tissue plasminogen activator (IV tPA). For those patients who are ineligible for IV tPA, one option includes intra arterial (IA) treatment, and consists of puncturing a large artery placing catheters and wires to access the blood vessels supplying oxygen to the brain. Since the late 1990s the field of intra arterial therapy has rapidly evolved. The first generation of devices were aspiration catheters with maceration wires that were positioned next to intra arterial clots and used to restore blood flow. More recently, physicians have begun directly aspirating blood clots, which allows for restoration of blood flow to occur in minutes. The importance of quickly treating patients with acute ischemic stroke has been borne out in several studies, demonstrating the fact that the faster a patient’s blood flow to the brain is restored, the faster they will recover. The goal of quickly restoring blood flow to the brain is to provide patients with the best chance at a good recovery.