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Current Cardiology Reports

, 21:112 | Cite as

Endovascular Thrombectomy for Acute Ischemic Stroke

  • Tasneem F. Hasan
  • Nathaniel Todnem
  • Neethu Gopal
  • David A. Miller
  • Sukhwinder S. Sandhu
  • Josephine F. Huang
  • Rabih G. TawkEmail author
Stroke (JF Meschia, Section Editor)
  • 252 Downloads
Part of the following topical collections:
  1. Topical Collection on Stroke

Abstract

Purpose of Review

To review the current evidence supporting the use of endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).

Recent Findings

Recent advances in AIS management by EVT have led to significant reduction in morbidity and mortality in selected patients with LVO within the anterior circulation. Until recently, use of EVT was strictly based on time criteria, within 4.5 to 12 h of symptom onset with many patients presenting with “wake-up” stroke who were not considered for EVT. The positive results of the DAWN and DEFUSE-3 trials have shown benefit in extending the therapeutic window for EVT to 24 and 16 h, respectively, after last known normal (LKN) time in the setting of large ischemic penumbra. These trials represent a paradigm shift in contemporary treatment of AIS, changing from a purely time-based decision to treat to an individualized decision based on clinical and radiographic findings of salvageable tissue.

Summary

Overall, acute stroke management has evolved considerably over the years from intravenous thrombolysis to include EVT, with paralleled improvements in patient selection and thrombectomy devices. Since the results of the DAWN and DEFUSE-3, EVT is now considered the standard of care in select patients with anterior circulation LVO up to 24 h from LKN time. Despite these developments, post-stroke disability remains pervasive and further studies are warranted in establishing the role of EVT in posterior circulation and distal vessel occlusions, with need for development of new and effective techniques for revascularization of small vessels.

Keywords

Acute ischemic stroke Endovascular Thrombectomy DAWN DEFUSE 3 Stent retrievers 

Notes

Compliance with Ethical Standards

Conflict of Interest

Tasneem F. Hasan, Nathaniel Todnem, Neethu Gopal, David A. Miller, Sukhwinder S. Sandhu, Josephine F. Huang, and Rabih G. Tawk declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tasneem F. Hasan
    • 1
  • Nathaniel Todnem
    • 2
  • Neethu Gopal
    • 3
  • David A. Miller
    • 4
  • Sukhwinder S. Sandhu
    • 3
  • Josephine F. Huang
    • 5
  • Rabih G. Tawk
    • 3
    Email author
  1. 1.Department of NeurologyOchsner Louisiana State University Health Sciences CenterShreveportUSA
  2. 2.Department of Neurologic SurgeryMedical College of GeorgiaAugustaGeorgia
  3. 3.Department of Neurologic SurgeryMayo ClinicJacksonvilleUSA
  4. 4.Department of Diagnostic RadiologyMayo ClinicJacksonvilleUSA
  5. 5.Department of NeurologyMayo ClinicJacksonvilleUSA

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