title: Endovascular Treatment of Acute Stroke: Evolution and Selection of Techniques and Instruments Based on Thrombus Imaging.
abstract: Mechanical thrombectomy provides higher recanalization rates than intravenous or intra-arterial thrombolysis. Finally this has been shown to translate into improved clinical outcome in six multicentric randomized controlled trials. However, within cohorts the clinical outcomes may vary, depending on the endovascular techniques applied. Systems aiming mainly for thrombus fragmentation and lacking a protection against distal embolization have shown disappointing results when compared to recent stent-retriever studies or even to historical data on local arterial fibrinolysis. Procedure-related embolic events are usually graded as adverse events in interventional neuroradiology. In stroke, however, the clinical consequences of secondary emboli have so far mostly been neglected and attributed to progression of the stroke itself. We summarize the evolution of instruments and techniques for endovascular, image-guided, microneurosurgical recanalization in acute stroke, and discuss how to avoid procedure-related embolic complications.
authors.affiliation: Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Liebig
authors.affiliation: Institute for diagnostic and interventional Neuroradiology, Inselspital - University Hospital, 3010, Bern, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Gralla
authors.affiliation: Institute for diagnostic and interventional Neuroradiology, Inselspital - University Hospital, 3010, Bern, Switzerland. Gerhard.schroth@insel.ch.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
mesh_terms: D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D017755:Prosthesis Fitting / Q000379:methods; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D013673:Technology Assessment, Biomedical / Q000379:methods
keywords: NIRS; Near-infrared spectroscopy; Stent retriever; Stroke; Thrombus imaging