History and Overview of Endovascular Stroke Therapy

Abstract

Acute ischemic stroke is the primary cause of acquired disability in adults and is the second leading cause of death worldwide. Following the introduction of intravenous thrombolysis, endovascular stroke therapy has hugely evolved over the past two decades. Although results of the 2013 randomized trials of endovascular stroke therapy were neutral, they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. In the year of 2015, there has been great progress in this field with five randomized clinical trials all proving the safety and efficacy of endovascular stroke treatment. Despite some differences in the details of eligibility requirements and processes, all five trials required several key factors for good functional recovery: (1) noninvasive imaging to prove proximal occlusion and to exclude large infarct core and (2) establishing a fast workflow to achieve effective reperfusion. The results indicate that modern thrombectomy devices can achieve faster and more effective reperfusion, so they lead to improved clinical outcomes compared with intravenous thrombolysis alone. There have not been major safety concerns, with a low rate of procedure-related complications and without an increase in symptomatic intracerebral hemorrhage or death. Such advances in mechanical thrombectomy techniques hold promise in the global fight against ischemic stroke-related acquired disability and mortality. In this chapter, the recent evolutionary process of endovascular stroke therapy will be discussed in more detail.