Current and Investigational Reperfusion Strategies in Acute Ischemic Stroke

Reperfusion Approaches
Recanalization or antegrade
    IV and/or IATThrombolytic agents: plasminogen activators, direct fibrinolytics, fibrinogenolytic agents; adjunctive therapy: heparin, direct thrombin inhibitors, GP IIb/IIIa antagonists
    Endovascular thrombectomyDistal devices: Merci,* Phenox, Neuronet, Catch, Attractor-18; proximal devices: Alligator, In-Time Retriever, snares
    Endovascular thromboaspirationPenumbra,* AngioJet, F.A.S.T. Funnel Catheter
    Mechanical thrombus disruptionMicroguidewire, snares, balloon angioplasty, OmniWave
    Transcranial or endovascular augmented fibrinolysisTranscranial Doppler, EKOS MicroLysUS, OmniWave
    Endovascular thrombus entrapmentSES and balloon-expandable stents
    Temporary endovascular bypassResheathable (closed-cell) stents, ReVasc
    Global reperfusion (flow augmentation or transarterial retrograde reperfusion)Pharmacologic: vasopressors (eg, phenylephrine); mechanical: NeuroFlo
    Transvenous retrograde reperfusion (flow reversal)Partial: retrograde transvenous neuroperfusion; complete: ReviveFlow
  • Note:—IV indicates intravenous; IAI, intra-arterial thrombolysis; GP IIb/IIIa, glycoprotein IIb/IIIa; SES, self-expanding stents.

  • * The Merci retriever and Penumbra systems have been approved by the FDA to “remove blood clots from the brain in patients experiencing an ischemic stroke.” The remaining drugs and devices constitute off-label and/or investigational (preclinical or clinical) usage.