Mechanical thrombectomy for the treatment of acute ischemic stroke.
Acute ischemic stroke is the leading cause of severe disability and the third leading cause of death in the USA. Intravenous tissue plasminogen activator (IV tPA) remains the most widely advocated treatment, but this therapy is limited by a narrow time window (<4.5 h after stroke onset), exclusion of patients with coagulopathy and recanalization rates of less than 50%. As a result, only 5% of acute stroke patients are treated with IV tPA. Endovascular mechanical thrombectomy may be employed, either as a standalone therapy or as an adjunct to IV tPA, and has several potential advantages, including a wider time window (up to 8 h), the capacity for use in coagulopathic patients and higher recanalization rates (up to 82%). Nonetheless, mechanical thrombectomy has engendered controversy because no randomized trials have yet been performed to support its use. In this article, we review the clinical applications of mechanical thrombectomy for the treatment of acute ischemic stroke. Ultimately, the results of ongoing trials are necessary to delineate the patient populations most likely to benefit from this therapy.
Fields
Jeremy D
JD
Neurosciences Critical Care, Department of Neurology, Interventional Neuroradiology, Dotter Interventional Institute, Oregon Health and Science University, OR, USA.
Lindsay
Kurt
K
Liu
Kenneth C
KC
Nesbit
Gary M
GM
Lutsep
Helmi L
HL
D000208:Acute Disease; D001778:Blood Coagulation Disorders / Q000150:complications; D002545:Brain Ischemia / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator