Abstract
Stroke is the third leading cause of death in the USA. An estimated 795,000 new or recurrent stroke events occur annually, mostly ischemic in nature. Arterial recanalization and subsequent reperfusion performed shortly after symptom onset can help to restore brain function in acute ischemic stroke (AIS). The only treatment currently approved by the United States Food and Drug Administration is intravenous tissue plasminogen activator, administered within 4.5 h of symptom onset. However, this short window often precludes effective intervention. Mechanical neurothrombectomy devices offer many potential advantages over pharmacologic thrombolysis, including more rapid achievement of recanalization, enhanced efficacy in treating large-vessel occlusions, and a potentially lower risk of hemorrhagic events. The goal of this chapter is to describe the state-of-the-art neurothrombectomy devices and stenting techniques for endovascular treatment of acute ischemic stroke, as well as to highlight recent advances in reperfusion therapies. Ongoing clinical trials, some with randomized, controlled designs, are included.
Keywords
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- AIS:
-
Acute ischemic stroke
- ASPECTS:
-
Alberta Stroke Program Early CT Score
- BA:
-
Basilar artery
- CT:
-
Computed tomography
- ECASS:
-
European Cooperative Acute Stroke Study
- FDA:
-
Food and Drug Administration
- IAT:
-
Intra-arterial thrombolysis
- ICA:
-
Internal carotid artery
- IMS:
-
Interventional Management of Stroke
- INR:
-
International normalized ratio
- IVT:
-
Intravenous thrombolysis
- IV-tPA:
-
Intravenous tissue plasminogen activator
- MCA:
-
Middle cerebral artery
- MERCI:
-
Mechanical Embolus Removal in Cerebral Ischemia
- MRI:
-
Magnetic resonance imaging
- mRS:
-
Modified Rankin Scale
- NIHSS:
-
National Institutes of Health Stroke Scale
- NINDS:
-
National Institute of Neurological Disorders and Stroke
- pCR:
-
Phenox clot retriever
- PROACT:
-
Prolapse in Acute Cerebral Thromboembolism
- PS:
-
Penumbra System
- sICH:
-
Symptomatic intracranial hemorrhage
- TICI:
-
Thrombolysis in Cerebral Ischemia
- TIMI:
-
Thrombolysis in Myocardial Infarction
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Raphaeli, G., Mazighi, M., Pereira, V.M., Turjman, F., Striefler, J. (2015). State-of-the-Art Endovascular Treatment of Acute Ischemic Stroke. In: Schramm, J. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 42. Springer, Cham. https://doi.org/10.1007/978-3-319-09066-5_3
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