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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
A review of endovascular treatment for medium vessel occlusion stroke
Johanna Maria Ospel1,2, Mayank Goyal3,4
1Radiology, Universitatsspital Basel, Basel, Switzerland.
Abstract:
Medium-vessel occlusions (MeVOs), that is, occlusions of the M2/3 middle cerebral artery, A2/3 anterior cerebral artery, and P2/3 posterior cerebral artery segments, account for 25%-40% of all acute ischemic stroke cases. Clinical outcomes of MeVO stroke with intravenous thrombolysis, which is the current standard of care, are moderate at best. With improving imaging technologies and a growing literature, MeVOs are increasingly recognized as a target for endovascular treatment (EVT). For the time being, there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke, despite the lack of clear guideline recommendations. In this article, we review the evidence on endovascular treatment for MeVO stroke and summarize the available literature on current imaging strategies, commonly used EVT selection criteria, EVT techniques, and outcome assessment for MeVO stroke.
Insights
Medium-vessel occlusions (MeVOs) are common in ischemic stroke. Endovascular treatment (EVT) shows promise for MeVO stroke, offering better outcomes than current standards, though guidelines are still developing.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Medium-vessel occlusions (MeVOs) represent a significant portion (25%-40%) of acute ischemic stroke cases.
- Current standard treatment, intravenous thrombolysis, yields only moderate clinical outcomes for MeVO stroke.
Purpose of the Study:
- To review existing evidence on endovascular treatment (EVT) for MeVO stroke.
- To summarize current imaging, selection criteria, techniques, and outcome assessment for MeVO EVT.
Main Methods:
- Literature review of studies on endovascular treatment for medium-vessel occlusions.
- Analysis of current imaging modalities and EVT selection criteria.
- Summary of commonly employed EVT techniques and outcome measures.
Main Results:
- Growing recognition of MeVOs as targets for EVT due to improving imaging.
- Limited but promising evidence suggests safety and efficacy of MeVO EVT.
- Increasing adoption of EVT for MeVO stroke despite lack of formal guidelines.
Conclusions:
- MeVO stroke is a critical area for intervention.
- EVT is an emerging and promising treatment for MeVO stroke.
- Further research and guideline development are needed for optimal MeVO EVT implementation.
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