Endovascular Management and Treatment of Acute Ischemic Stroke

• Published in: Neurosurgery clinics of North America Vol. 25; no. 3; pp. 583 - 592
• Main Authors: Mokin, Maxim, MD, PhD, Snyder, Kenneth V., MD, PhD, Siddiqui, Adnan H., MD, PhD, Hopkins, L. Nelson, MD, Levy, Elad I., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2014
• Subjects: Acute Disease; Acute ischemic stroke; Brain Ischemia - diagnosis; Brain Ischemia - therapy; Endovascular intervention; Endovascular Procedures; Humans; Intra-arterial therapy; Large vessel occlusion; Mechanical Thrombolysis; Neurosurgery; Stentriever; Stents; Stroke - diagnosis; Stroke - therapy; Thrombectomy; Treatment Outcome; Thrombectomy; Endovascular intervention; Intra-arterial therapy; Acute ischemic stroke; Large vessel occlusion; Stentriever
• ISSN: 1042-3680; 1558-1349
• DOI: 10.1016/j.nec.2014.04.013

Endovascular intra-arterial therapy is reserved for strokes from large vessel occlusion. This article reviews the critical role of the location of the occlusion, extent and characteristics of the occlusive thrombus on noninvasive imaging, and identification of ischemic core and salvageable tissue on perfusion imaging for proper patient selection. The advantages of stentrievers over other mechanical thrombectomy approaches are discussed and the role of the aspiration thrombectomy approach in modern clinical practice is reviewed. Finally, the implications of the results of recent randomized trials of endovascular therapy on the future of intra-arterial revascularization therapies are discussed.