title: Acute Ischemic Stroke Intervention.
abstract: Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evolution of catheter-based treatment from first-generation thrombectomy devices to the game-changing stent retrievers, results from recent trials, and the evolving stroke systems of care to provide timely access to acute stroke intervention to patients in the United States.
authors.affiliation: Department of Interventional Neuroradiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Priyank
authors.initials: P
authors.lastname: Khandelwal
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida; Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: DYavagal@med.miami.edu.
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: rsacco@med.miami.edu.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D018810:Magnetic Resonance Angiography; D059906:Neuroimaging; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: large vessel occlusion; mechanical thrombectomy; stent retrievers; stroke systems