A trial of imaging selection and endovascular treatment for ischemic stroke

Endovascular treatment of acute ischemic stroke

Endovascular stroke therapy has revolutionized the management of patients with acute ischemic stroke in the last decade and has facilitated the development of sophisticated stroke imaging techniques and a multitude of thrombectomy devices. This article reviews the scientific basis and current evidence available to support endovascular revascularization and provides brief technical details of the various methods of endovascular thrombectomy with case examples.

Unanswered questions in thrombolytic therapy for acute ischemic stroke

This article reviews some of the current literature in support or against extension of the intravenous tissue plasminogen activator window, use of intra-arterial therapy or devices, as well alternative pharmacologic therapies that may extend the window for treatment of patients with acute ischemic stroke, with consideration of the relative risk of thrombolytic complications, factors for worse outcomes, and unclear stroke onset, as seen in patients with wake-up stroke. The issue of newer concomitant antithrombotic therapies as they affect the decision for acute ischemic stroke thrombolytic therapy is also explored.

Emerging issues in acute ischemic stroke

In this update we review studies on a wide range of topics, from diagnostic aspects of acute stroke to the clinical implications of the complex interaction between the brain and the immune system. Recent randomized trials and observational studies have reinforced the effectiveness of intravenous thrombolysis with t-PA in patients that qualify for this treatment, including patients presenting with mild symptoms or on subtherapeutic oral anticoagulation. Despite all the negative studies on the endovascular treatment of acute stroke, the utility of newer mechanical thrombectomy devices in patients with stroke and large vessel occlusion is being assessed in ongoing clinical trials. In addition to the various revascularization therapies that have a limited time window, treatments aimed at protecting the neurovascular unit may be used in more patients if their efficacy is confirmed in humans, and experimental studies suggest that the modulation of specific aspects of the immune system may increase the likelihood of successful recovery after cerebral ischemia.

Endovascular thrombectomy following acute ischemic stroke: a single-center case series and critical review of the literature

Acute ischemic stroke (AIS) due to thrombo-embolic occlusion in the cerebral vasculature is a major cause of morbidity and mortality in the United States and throughout the world. Although the prognosis is poor for many patients with AIS, a variety of strategies and devices are now available for achieving recanalization in patients with this disease. Here, we review the treatment options for cerebrovascular thromboembolic occlusion with a focus on the evolution of strategies and devices that are utilized for achieving endovascular clot extraction. In order to demonstrate the progression of this treatment strategy over the past decade, we will also present a single-center case series of AIS patients treated with endovascular thrombectomy.