title: Endovascular stroke therapy.
abstract: BACKGROUND
  Following the development of intravenous thrombolysis as a successful treatment for ischaemic stroke, advances in neurointerventional radiology have facilitated endovascular approaches to treatment. This article reviews the available endovascular therapeutic options and their evidence-base.
  
  
  CONCLUSIONS
  Initial studies demonstrated that endovascular treatment of ischaemic stroke with intra-arterial thrombolysis and/or the use of clot-retrieval, thrombus aspiration and stent-retriever devices produced early recanalisation and reperfusion and improved neurological outcome. More recent randomised trials, however, have failed to show translation of recanalisation into successful clinical outcome with 'time to treatment' proving crucial. In this rapidly evolving field, combined therapy incorporating intravenous and intra-arterial thrombolysis in combination with endovascular clot-retrieval has been developed and further studies are expected to yield better evidence to guide the optimal treatment of acute cerebral ischaemia.
authors.affiliation: Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom. Electronic address: jonathan.birns@gstt.ns.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Birns
authors.affiliation: Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Sam
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: Department of Health and Social Care Research, King's College London, London, United Kingdom.
authors.forename: Ruoling
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Ageing & Health, St Thomas' Hospital, London, United Kingdom; Department of Stroke Medicine, King's College Hospital, London, United Kingdom; Department of Health and Social Care Research, King's College London, London, United Kingdom.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bhalla
mesh_terms: D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Clot retrieval; Endovascular; Intra-arterial; Stroke; Thrombolysis