Acute stroke endovascular treatment: tips and tricks

J Cardiovasc Surg (Torino). 2016 Dec;57(6):758-768. Epub 2016 Sep 21.

Abstract

Acute ischemic stroke is a leading cause of death and disability in the United States, responsible for 1 of every 20 deaths. The efficacy of intravenous tissue plasminogen activator (tPA) alone for recanalization of large-vessel occlusion (LVO) is low. Several randomized trials have now established endovascular treatment of LVO as a standard of care. Endovascular techniques continue to evolve at a rapid pace. This review seeks to report recent advances in endovascular technology, discuss the correlation between speed of reperfusion and patient outcomes, and present mobile stroke care, shortcoming of the recent technology (such as clot fragmentation), and potential solutions to overcome these drawbacks, as well as anesthetic considerations and cost-effectiveness.

Publication types

  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Diffusion of Innovation
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Endovascular Procedures / trends
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Health Care Costs
  • Humans
  • Infusions, Intravenous
  • Prosthesis Design
  • Risk Factors
  • Stents
  • Stroke / diagnostic imaging
  • Stroke / drug therapy*
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Thrombolytic Therapy / trends
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome
  • Vascular Access Devices

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator