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Updated: Mar 29, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Imaging-based selection for revascularization in acute ischemic stroke.

Volker Puetz¹, Kristian Barlinn, Ulf Bodechtel

¹aDepartment of Neurology, Technische Universität Dresden, Dresden University Stroke Centre, Dresden, Germany bDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia cDepartment of Neuroradiology, Technische Universität Dresden, Dresden University Stroke Centre, Dresden, Germany.

Current Opinion in Neurology

|December 8, 2015

Summary

This summary is machine-generated.

Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are key acute ischemic stroke treatments. Advanced imaging helps select patients who will benefit most from these revascularization therapies, especially in later time windows.

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Area of Science:

Neurology
Radiology
Cardiovascular Medicine

Background:

Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are established treatments for acute ischemic stroke.
Recent EVT trials confirm the efficacy of these revascularization strategies, often used alone or in combination.

Purpose of the Study:

To review how pre-treatment imaging findings can guide the selection of acute ischemic stroke patients most likely to benefit from IVT and EVT.
To highlight the role of imaging in identifying candidates for reperfusion therapies, particularly in extended time windows.

Main Methods:

Review of recent endovascular thrombectomy (EVT) trials and current literature on acute stroke treatment.
Analysis of the utility of vascular imaging in patient selection for revascularization therapies.

Main Results:

IVT within 4.5 hours remains a primary treatment; its efficacy diminishes in later windows.
Vascular imaging is essential for identifying intracranial occlusions before EVT.
Imaging markers like small ischemic core, good leptomeningeal collaterals, or penumbral tissue predict EVT benefit, even beyond 6 hours from symptom onset.

Conclusions:

Pretherapeutic imaging is crucial for identifying stroke patients who will benefit from endovascular therapies.
Imaging can extend the therapeutic window for EVT by identifying suitable candidates.