Current and Investigational Reperfusion Strategies in Acute Ischemic Stroke
| Reperfusion Approaches | |
|---|---|
| Recanalization or antegrade | |
| IV and/or IAT | Thrombolytic agents: plasminogen activators, direct fibrinolytics, fibrinogenolytic agents; adjunctive therapy: heparin, direct thrombin inhibitors, GP IIb/IIIa antagonists |
| Endovascular thrombectomy | Distal devices: Merci,* Phenox, Neuronet, Catch, Attractor-18; proximal devices: Alligator, In-Time Retriever, snares |
| Endovascular thromboaspiration | Penumbra,* AngioJet, F.A.S.T. Funnel Catheter |
| Mechanical thrombus disruption | Microguidewire, snares, balloon angioplasty, OmniWave |
| Transcranial or endovascular augmented fibrinolysis | Transcranial Doppler, EKOS MicroLysUS, OmniWave |
| Endovascular thrombus entrapment | SES and balloon-expandable stents |
| Temporary endovascular bypass | Resheathable (closed-cell) stents, ReVasc |
| Alternative | |
| 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.