Update on Large-Vessel Revascularization in Acute Ischemic Stroke

AbstractPurpose of reviewThis review presents the critical appraisal of current therapeutic strategies for patients with large-vessel occlusion (LVO) acute ischemic stroke (AIS). We provide the reader with most recent evidence supporting endovascular thrombectomy (EVT), different techniques used for thrombectomy, and highlight knowledge gaps regarding therapeutic efficacy of this intervention in respective subgroup of these patients based on site of occlusion, size of ischemic core, time from symptom onset, utility of concurrent intravenous thrombolysis (IVT), mild strokes, or tandem occlusions.Recent findingsEVT is the established standard of care for patients with moderate-severe LVO-AIS presenting within 24  h of symptom onset and favorable perfusion imaging irrespective of IVT. The DIRECT-MT and SKIP randomized clinical trials (RCT) established that EVT without IVT for eligible patients is not non-inferior to concurrent IVT. The RESCUE-Japan LIMIT randomized controlled trial showed EVT in patients w ith ASPECTS score of 3–5 presenting within 6 h of symptom onset or within 24 h if no early ischemic change was seen on MRI FLAIR sequence. Good functional outcome at 90 days (mRS 0–3) was seen in 31% patients undergoing EVT and only in 12.7% in the medical group (relative risk 2.43, 95%CI 1.3 5–4.37,p = 0.002). Any ICH was notably higher in the EVT group (58% versus 31.4%,p <  0.001). The SELECT-2 RCT enrolled patients with CT ASPECTS of 3–5, or CT or...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research