Management of acute ischemic stroke: current status of pharmacological and mechanical endovascular methods.
OBJECTIVE
To provide the current strategies of acute stroke management using pharmacological and interventional endovascular modalities.


METHODS
Review of the literature for publications in English language literature on endovascular pharmacological and mechanical thrombolysis and clot retrieval.


RESULTS
Aggressive management protocols have yielded therapeutic windows for effective reperfusion of ischemic brain in acute cerebral hypoperfusion/stroke. Starting with intravenous infusion of thrombolytics, which still remains to be the best feasible treatment for acute stroke management, recent advances in neuron imaging made it possible to utilize emergency cerebral angiographic evaluation of intracranial vessels followed by therapeutic measure that could be pharmacological or mechanical intervention. Intra-arterial clot lysis under image guidance combined with intravenous administration of thrombolytic is rapidly evolving with encouraging results. Microcatheters and endovascular appliances tested very positively, yielding better outcomes in acute stroke. MERCI trial, Multi MERCI trial and Stroke trials [emergency management of stroke (EMS) and interventional management of stroke (IMS)] have shown that early recanalization and reperfusion constitute good prognostic indicators by reducing mortality and improving neurological outcomes. Further trials are expected to yield better evidence to form guidelines for aggressive management of acute cerebral ischemia.


CONCLUSIONS
Intravenous fibrinolysis is, to date, the best possible intervention in acute stroke and has been shown to be a better alternative to aspirin, the only known effective, pharmacological treatment. Endovascular interventions have shown very promising results with intra-arterial administration of thrombolytics as well as mechanical clot retrieving methods.
Williams
Michael
M
Department of Neurosurgery and Department of Radiology, LSUHSC-Shreveport, Shreveport, LA 71130-3932, USA. mwil18@lsuhsc.edu
Patil
Shashikant
S
Toledo
Eduardo Gonzalez
EG
Vannemreddy
Prasad
P
D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents