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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

[Consensus and controversy in the treatment of ischemic cerebrovascular diseases]

Nobuyuki Sakai1, Terumasa Kuroiwa, Manabu Sakaguchi

  • 1Department of Neurosurery, Kobe City General Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|January 18, 2005
PubMed

Insights

Endovascular treatments like intra-arterial fibrinolysis and carotid stenting offer alternatives for ischemic cerebrovascular diseases (CVD) when patients miss the early treatment window. Further research is ongoing for intracranial stenting.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Radiology

Context:

  • Ischemic cerebrovascular diseases (CVD) require careful treatment selection, balancing medical management with surgical and endovascular interventions.
  • Many patients with acute cerebral embolism present beyond the 3-hour window for intravenous thrombolysis, necessitating alternative therapies.
  • Carotid angioplasty and stenting (CAS) is emerging as a viable alternative to carotid endarterectomy (CEA), particularly for high-risk patients.

Purpose:

  • To review current consensus and controversies in the endovascular treatment of ischemic cerebrovascular diseases.
  • To discuss the efficacy and ongoing research of various endovascular revascularization techniques.
  • To explore future perspectives in the management of ischemic CVD.

Summary:

  • Intra-arterial fibrinolysis shows promise for acute cerebral embolism beyond 3 hours, with PROACT-II demonstrating improved outcomes despite increased hemorrhage risk.
  • Carotid stenting (CAS) is a safe and effective option for high-risk patients unsuitable for carotid endarterectomy (CEA), as suggested by the SAPPHIRE study.
  • While intracranial stenting lacks robust clinical evidence and devices, it holds potential for future treatment of symptomatic intracranial stenosis.

Impact:

  • Provides an overview of advanced endovascular treatment options for ischemic cerebrovascular diseases.
  • Highlights the importance of considering alternative therapies for patients outside the standard thrombolytic window.
  • Informs clinicians about ongoing trials (MELT-Japan, CREST, CSSA) and future directions in cerebrovascular intervention.

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