American Journal of Neuroradiology 2009;30:859.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
American Journal of Neuroradiology
DOI 10.3174/ajnr.A1604
REVIEW ARTICLE
Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials
From the Endovascular Neurosurgery/Interventional Neuroradiology Section (R.G.N., A.J.Y., J.A.H.), Departments of Radiology and Neurosurgery; and Neurocritical Care and Vascular Neurology Section (R.G.N., F.S.B.), 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: Reperfusion remains the mainstay of acute ischemic stroke treatment. Endovascular therapy has become a promising alternative for patients who are ineligible for or have failed intravenous (IV) thrombolysis. The conviction that recanalization of properly selected patients is essential for the achievement of good clinical outcomes has led to the rapid and widespread growth in the adoption of endovascular stroke therapies. However, comparisons of the recent reperfusion studies have brought into question the strength of the association between revascularization and improved clinical outcome. Despite higher rates of recanalization, the mechanical thrombectomy studies have demonstrated substantially lower rates of good outcomes compared with IV and/or intra-arterial thrombolytic trials. However, such analyses disregard important differences in clot location and burden, baseline stroke severity, time from stroke onset to treatment, and patient selection in these studies. Many clinical trials are testing novel devices and drugs as well as the paradigm of physiology-based stroke imaging as a treatment-selection tool. The objective of this article is to provide a comprehensive review of the relevant past, current, and upcoming data on endovascular stroke therapy with a special focus on the prospective studies and randomized clinical trials.