Recent advances in the interventional treatment of acute ischemic stroke

Acute ischemic stroke is a major cause of morbidity and mortality in Europe, North America, and Asia. Recent advances over the past decade have been made in the interventional approach to patients with a stroke. These include intravenous (i.v.) trials, intra-arterial (i.a.) trials, combined i.v./i.a. trials, and newer devices undergoing current clinical evaluation to mechanically remove clot within the cerebral circulation.

A summary of the latest interventional approaches to stroke, from the interventional neuroradiology perspective, is presented. Results of the major thrombolytic trials over the past decade are summarized. Newer devices and approaches for ischemic stroke patients, including the recently completed Phase 1/2 MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial are presented.

The Proact 1 and 2 trials involving i.a. thrombolytic therapy in patients who present with an acute middle cerebral artery stroke within 6 h from symptom onset have demonstrated significant benefit over the control group, for improved outcomes at 90 days. The MERCI trial has demonstrated, in 114 patients with moderate to severe strokes, that patients who are able to be recanalized have significant neurological improvement versus those who were not able to be recanalized.

Continued advances in the interventional approach to acute stroke treatment, with further clinical trials, are warranted. Early reports are encouraging regarding both combination thrombolytic drug trials and mechanical device trials for these patients.