Endovascular cerebral recanalization procedures

Yogesh Moradiya MD (Dr. Moradiya of Johns Hopkins University Medical Center has no relevant financial relationships to disclose.)
Pravin George DO (Dr. George of Johns Hopkins University Medical Center has no relevant financial relationships to disclose.)
Claude Nguyen MD (Dr. Nguyen of University of Texas Medical Center at Houston has no relevant financial relationships to disclose.)
Nazli Janjua MD (Dr. Janjua of Pomona Valley Hospital Medical Center has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released August 27, 2011; last updated December 1, 2014; expires December 1, 2017

Overview

Though systemic thrombolysis offered the first effective morbidity-reducing treatment for acute ischemic stroke, this promising treatment strategy does not reduce mortality rates and may be less effective in patients with large artery occlusion. This has led to the continued refinement of endovascular treatment strategies, including intra-arterial thrombolysis, mechanical thrombus extraction, and percutaneous transluminal angioplasty and stenting. Stenting and angioplasty are also utilized for select stroke patients in the subacute period, with intra- or extracranial stenoses. Finally, surgical revascularization, such as direct or indirect bypass, offers a means of restoring cerebral blood flow to an even more select group of patients with permanent occlusion of the cerebrovascular circulation. The author discusses roles and supporting evidence of these recanalization techniques in ischemic stroke.

Key points

• Intra-arterial thrombolysis and mechanical thrombectomy are treatment options in acute ischemic stroke for patients with contraindication to intravenous thrombolysis or as an adjunct to thrombolytic therapy.

• Various non-pharmacological recanalization methods have been used alone or in combination with thrombolytic medications.

• Subacute recanalization by intra- and extracranial stenting continues to undergo evolution. Whereas carotid stenting has been established as a treatment option for select patients with extracranial disease, intracranial stenting may be associated with higher morbidity and mortality compared with medical management in patients with intracranial atherosclerosis.

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