Current advances in endovascular treatment
- PMID: 36762653
- DOI: 10.1097/WCO.0000000000001142
Current advances in endovascular treatment
Abstract
Purpose of review: Endovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients' selection and periprocedural management.
Recent findings: Recent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability.
Summary: The field of EVT is rapidly evolving. The results of recent trials have dramatically increased the indications for EVT, with many ongoing trials examining further indications.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
References
-
- Chen CJ, Ding D, Starke RM, et al. Endovascular vs medical management of acute ischemic stroke. Neurology 2015; 85:1980–1990.
-
- Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387:1723–1731.
-
- Jadhav AP, Desai SM, Jovin TG. Indications for mechanical thrombectomy for acute ischemic stroke: current guidelines and beyond. Neurology 2021; 97:S126–s136.
-
- Trifan G, Biller J, Testai FD. Mechanical thrombectomy vs bridging therapy for anterior circulation large vessel occlusion stroke: systematic review and meta-analysis. Neurology 2022; 98:e1361–e1373.
-
- Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT Randomized Clinical Trial. JAMA 2021; 325:234–243.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials
