James A Giles1, Ananth K Vellimana2, Opeolu M Adeoye3,4. 1. Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. 2. Departments of Neurosurgery, Neurology and Radiology, Washington University School of Medicine, St. Louis, MO, USA. 3. Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA. adeoye@wustl.edu. 4. BJC HealthCare Distinguished Professor of Emergency Medicine & Chair, Department of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Ave., Campus, Box 8072, St. Louis, MO, 63110, USA. adeoye@wustl.edu.
Abstract
PURPOSE OF REVIEW: In the USA, around 30% of 795,000 strokes per year are due to proximal large-vessel occlusion, and these are a major cause of death and disability. We review the most recent advances regarding treatment of ischemic stroke amenable to mechanical thrombectomy. RECENT FINDINGS: In the last four years, clinical trial evidence has expanded the time window for successful endovascular treatment to 24 h. Current research is aimed at expanding patient selection to mild strokes, large ischemic cores and occlusions of smaller, more distal blood vessels. Further, we have developed understanding of how to manage blood pressure after thrombectomy and even had promising results for a neuroprotective agent in these patients. Thrombectomy has transformed the treatment of ischemic stroke due to large-vessel occlusion. Recent research has focused on expanding patient candidacy for endovascular treatment and improving medical management to support better neurologic outcomes.
PURPOSE OF REVIEW: In the USA, around 30% of 795,000 strokes per year are due to proximal large-vessel occlusion, and these are a major cause of death and disability. We review the most recent advances regarding treatment of ischemic stroke amenable to mechanical thrombectomy. RECENT FINDINGS: In the last four years, clinical trial evidence has expanded the time window for successful endovascular treatment to 24 h. Current research is aimed at expanding patient selection to mild strokes, large ischemic cores and occlusions of smaller, more distal blood vessels. Further, we have developed understanding of how to manage blood pressure after thrombectomy and even had promising results for a neuroprotective agent in these patients. Thrombectomy has transformed the treatment of ischemic stroke due to large-vessel occlusion. Recent research has focused on expanding patient candidacy for endovascular treatment and improving medical management to support better neurologic outcomes.
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