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Evolution of endovascular mechanical thrombectomy for acute ischemic stroke

World journal of clinical cases 2014年第11期2卷 614-622页

作者： c.lin j przybylowski Dale Ding Robert M Starke christopher R Durst R Webster crowley Kenneth c Liu Department of Neurological Surgery University of VirginiaCharlottesvilleVA 22908United States Department of Radiology and Medical Imaging University of Virginia Charlottesville VA 22908 United States

Acute ischemic stroke(AIS) is a common medical problem associated with significant morbidity and mortality worldwide. A small proportion of AIS patients meet eligibility criteria for intravenous thrombolysis(IVT) with recombinant tissue plasminogen activator, and its efficacy for large vessel occlusion is poor. Therefore, an increasing number of patients with AIS are being treated with endovascular mechanical thrombectomy when IVT is ineffective or contraindicated. Rapid advancement in catheter-based and endovascular device technology has led to significant improvements in rates of cerebral reperfusion with these devices. Stentrievers and modern aspiration catheters have now surpassed earlier generation devices in the degree and rapidity of revascularization. This progress has been achieved with no concurrent increase in risk of major complications or mortality, both when used alone or in combination with IVT. The initial randomized controlled trials comparing endovascular therapy to IVT for AIS failed to show superior outcomes with endovascular treatment, butkey limitations of each trial may limit the significance of these results to current practice. While endovascular devices and operator experience continue to evolve, we are optimistic that this will be accompanied by improvements in patient outcomes. This review highlights the major endovascular devices used in current practice and the trials which have investigated their efficacy.

关键词： cerebral infarction Endovascular procedures Intracranial hemorrhages Stents Stroke

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