Related Experiment Video
Updated: May 6, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
14.4K
The goldilocks dilemma in acute ischemic stroke
Aaron P Tansy1, David S Liebeskind
1Department of Neurology, UCLA Stroke Center, University of California , Los Angeles, CA , USA.
Frontiers in Neurology
|October 25, 2013
Summary
Selecting the "just right" patients for endovascular stroke therapy is crucial for treatment success. A new model is proposed to improve patient selection beyond the "time is brain" approach for acute ischemic stroke.
Area of Science:
- Neurology
- Interventional Cardiology
- Neurosurgery
Background:
- Tissue plasminogen activator (t-PA) is the sole proven acute ischemic stroke treatment.
- Novel endovascular therapies show promise but have faced challenges in clinical trials.
Purpose of the Study:
- To address the critical need for improved patient selection in endovascular stroke treatment.
- To propose a new model for identifying patients who are ideal candidates for endovascular therapy, termed the "Goldilocks dilemma".
Main Methods:
- Review of key clinical criteria from past endovascular trials.
- Proposal of a new model that considers the dynamic nature of acute ischemic stroke.
- Examination of three clinical cases to illustrate the proposed model.
Main Results:
- Current patient selection methods may not adequately account for stroke complexity.
- A nuanced model is necessary to optimize endovascular treatment success.
- Clinical cases demonstrate the application of the proposed selection framework.
Conclusions:
- Solving the "Goldilocks dilemma" is essential for advancing endovascular stroke treatment.
- The proposed model offers a more dynamic approach to patient selection.
- Strategies for managing patients not ideal for endovascular therapy remain a priority.
Related Concept Videos
01:15Ischemic Stroke ll: Pathophysiology
74
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
74
01:15Ischemic Stroke l: Introduction
57
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
57
01:26Transient Ischemic Attack l: Introduction
35
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
35
01:29Hemorrhagic Stroke ll: Pathophysiology
57
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
57
01:17Hemorrhagic Stroke l: Introduction
41
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
41