Journal of Vascular and Interventional Radiology
New and Future Endovascular Treatment Strategies for Acute Ischemic Stroke
Section snippets
ENDOVASCULAR THROMBECTOMY
Endovascular thrombectomy involves the extraction of the thrombus through a catheter and should provide rapid recanalization and reduce the risk of distal embolic complications seen with mechanical clot disruption. This method may be used as a standalone technique or in conjunction with a markedly reduced dose of thrombolytic drug. The technical challenges of thrombectomy include intracranial navigation of these devices, capture of occlusive material within the tortuous and dividing cerebral
MECHANICAL CLOT DISRUPTION
Mechanical clot disruption includes any technique by which the interventionalist mechanically fragments or completely destroys the thrombus within the artery. This may be accomplished simply by using guide wire manipulation or in a more complex fashion such as laser shock-wave devices. The goal of mechanical clot disruption is to rapidly establish blood flow and cerebral perfusion. As the thrombus is disrupted and flow reestablished, small emboli are created and carried into distal branches. If
AUGMENTED FIBRINOLYSIS
In a broad sense, augmented fibrinolysis can use any method with a fibrinolytic to more rapidly recanalize and reperfuse the brain. Microcatheters, guide wires, or any of the embolectomy or mechanical devices mentioned earlier, when used in addition to fibrinolytics, should, in some sense, help accomplish this goal. The use of snares, nets, balloons, or other mechanical devices to fragment or disrupt a thrombolytic-laden embolus may greatly increase the rapidity of reperfusion. In a recent
CONCLUSION
At the present time, the mainstay of treatment for acute ischemic stroke is intravenous or intraarterial fibrinolysis. Other endovascular treatment strategies that can be applied in the treatment of acute stroke are now undergoing feasibility and safety studies.
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None of the authors have identified a potential conflict of interest.
Presented at the 2003 SIR Annual Meeting.