[Endovascular treatment of ischemic strokes : outcomes and practical issues]

Ischemic stroke is a leading cause of disability and death due to brain arterial occlusion and subsequent ischemia. Acute treatment aims to recanalize the occluded artery as soon as possible. Treatment to achieve recanalization of the occluded artery has evolved during the last couple of years. First therapeutic improvement : intra-veinous thrombolysis (IV rt-PA) was the first validated treatment to achieve reduction in ischemic stroke morbi-mortality. However, rt-PA is efficient in the first hours of stroke onset and for small calibers occluded vessels. Second therapeutic improvement : since 2015, mechanic thrombectomy in combination with IV rt-PA or alone, extended acute ischemic stroke treatment to large vessel occlusions that are responsible for most death and disability in stroke patients, and this, in a time window less restrictive than the 4,5hours after which the rt-PA is no longer effective. Discussion and practical issues : the aim of acute ischemic stroke treatment is to recanalize as soon as possible the occluded vessel to preserve as much viable brain tissue as possible. Here, we propose to base stroke work-up on injected brain computed tomography : before the contrast is injected, brain CT is sufficient for rt-PA infusion decision, then contrast injection can be made within another vein while rt-PA is injected to select patients with proximal occlusion in need of thrombectomy.