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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Acute endovascular recanalization: lessons from randomized controlled trials.

Martin Bendszus1, Werner Hacke

  • 1aDepartment of Neuroradiology bDepartment of Neurology, Center of Clinical Neurosciences, University Hospital, Ruprecht Karl Universität Heidelberg, Heidelberg, Germany.

Current Opinion in Neurology
|December 19, 2015
PubMed
Summary

Endovascular stroke treatment using stent retrievers significantly improves outcomes for large vessel occlusion. Recent trials confirm its benefit over conservative care, establishing it as the standard treatment.

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Acute ischemic stroke is a leading cause of disability.
  • Large vessel occlusion (LVO) stroke has historically poor outcomes.
  • Previous trials on endovascular stroke treatment yielded mixed results.

Purpose of the Study:

  • To review recent positive studies on endovascular stroke treatment (EST).
  • To compare new findings with previous negative trials.
  • To assess the impact of EST on patient outcomes.

Main Methods:

  • Review of five randomized controlled multicenter trials published since October 2014.
  • Focus on trials using stent retrievers as adjunct to conservative treatment.
  • Inclusion of patients with LVO (internal carotid or middle cerebral artery) within short time windows and small initial infarcts.

Main Results:

  • EST with stent retrievers showed overwhelming benefit in outcome (modified Rankin Scale, independent survival).
  • Adverse event rates, including hemorrhage, were not increased compared to conservative treatment alone.
  • Contrasts with earlier studies using older devices and different criteria, which showed neutral outcomes.

Conclusions:

  • Endovascular stroke treatment with stent retrievers is now the standard of care for LVO.
  • Further research is needed for extended indications (e.g., longer time windows, larger infarcts).
  • Investigating new devices beyond stent retrievers is warranted.