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AJNR - American Journal of Neuroradiology

Published ahead of print on March 11, 2009
doi: 10.3174/ajnr.A1486

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American Journal of Neuroradiology 30:649-661, April 2009
© 2009 American Society of Neuroradiology

Review Article

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

R.G. Nogueira^a,b, L.H. Schwamm^b and J.A. Hirsch^a

^a Endovascular Neurosurgery/Interventional Neuroradiology Section, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
^b Departments of Radiology and Neurosurgery, and Neurocritical Care and Vascular Neurology Section, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass

Please address correspondence to: Raul G. Nogueira, MD, Department of Interventional Neuroradiology and Endovascular Neurosurgery, Massachusetts General Hospital, 55 Fruit St, GRB-2-241, Boston, MA, 02114; e-mail: rnogueira{at}partners.org

SUMMARY: Despite years of research and pioneering clinical work, stroke remains a massive public health concern. Since 1996, we have lived in the era of US Food and Drug Administration–approved intravenous (IV) recombinant tissue plasminogen activator (rtPA). This treatment, despite its promise, continues to exhibit its limitations. Endovascular therapy has several theoretic advantages over IV rtPA, including site specificity, longer treatment windows, and higher recanalization rates. In this article, we will review the various pharmacologic strategies for acute stroke treatment, providing both a historic context and the state of the art. The drugs will be classified on the basis of their theoretic rationale for therapy. Next, we will review the various devices and strategies for mechanical revascularization with an aim toward comprehensiveness. These range from wire disruption of thrombus to preclinical trials for novel mechanical solutions. This first installment of this 2-part series will end with an analysis of retrograde reperfusion techniques.

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