title: Acute stroke endovascular treatment: tips and tricks.
abstract: Acute ischemic stroke is a leading cause of death and disability in the United States, responsible for 1 of every 20 deaths. The efficacy of intravenous tissue plasminogen activator (tPA) alone for recanalization of large-vessel occlusion (LVO) is low. Several randomized trials have now established endovascular treatment of LVO as a standard of care. Endovascular techniques continue to evolve at a rapid pace. This review seeks to report recent advances in endovascular technology, discuss the correlation between speed of reperfusion and patient outcomes, and present mobile stroke care, shortcoming of the recent technology (such as clot fragmentation), and potential solutions to overcome these drawbacks, as well as anesthetic considerations and cost-effectiveness.
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA - lnhopkins@icloud.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.forename: Gary B
authors.initials: GB
authors.lastname: Rajah
authors.forename: Hakeem J
authors.initials: HJ
authors.lastname: Shakir
authors.forename: Jason M
authors.initials: JM
authors.lastname: Davies
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017048:Health Care Costs; D006801:Humans; D007262:Infusions, Intravenous; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator