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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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[Border areas of thrombectomy].

Marios-Nikos Psychogios1, Alex Brehm2, Peter Sporns2

  • 1Abteilung für interventionelle und diagnostische Neuroradiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz. marios.psychogios@usb.ch.

Der Nervenarzt
|June 8, 2021
PubMed
Summary

Mechanical thrombectomy (MT) offers effective treatment for acute ischemic stroke (AIS). This review explores expanding MT indications to include more patients, such as those in extended time windows or with specific occlusion types.

Keywords:
Endovascular treatmentIschemic strokeMechanical thrombectomyTreatment indicationsVascular occlusion

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Mechanical thrombectomy (MT) is standard for acute ischemic stroke (AIS) from large anterior circulation artery occlusion.
  • Current guidelines exclude significant patient groups from this effective treatment.

Purpose of the Study:

  • To review potential expansions of MT indications.
  • To discuss recent advancements in interventional stroke treatment.

Main Methods:

  • Literature review and clinical experience synthesis.
  • Analysis of extended time windows, distal occlusions, large infarct cores, and pediatric/geriatric populations.
  • Discussion of novel triage strategies and adjunctive thrombolysis.

Main Results:

  • Identified patient subgroups currently excluded from MT.
  • Highlighted emerging interventional techniques and treatment paradigms.
  • Presented clinical estimations for expanded MT indications based on literature and experience.

Conclusions:

  • Evidence suggests expanding MT indications can benefit more AIS patients.
  • Further research and guideline updates are needed to incorporate these findings.
  • Optimizing patient selection and treatment protocols is crucial for improving stroke outcomes.