[Recanalization after cerebral ischemia]

Recanalization after cerebral ischemia. Acute ischemic stroke (AIS) management is based on stroke unit admission and arterial recanalization. Recanalization therapies include the endovascular approach (also called mechanical thrombectomy) and intravenous (IV) alteplase (i.e. thrombolysis). In the setting of AIS consecutive to large vessel occlusion of the anterior circulation (i.e. internal carotid and/or middle cerebral arteries), IV alteplase is associated to endovascular approach. IV alteplase alone being devoted to AIS without large vessel occlusion. The therapeutic window is of 4h30 for IV alteplase administration and 6 hours for endovascular approach. Using MRI and perfusion brain imaging, the therapeutic window may be individualized and extended up to 24 hours. Although this extended time window is an opportunity to treat more patients, the rapidity of recanalization remains critical, as it is a major predictor of clinical outcome, emphasizing the need to reduce, as much as possible, treatment delays.