Update On Acute Stroke Intervention

After the results of five positive trials being published in 2015, mechanical thrombectomy is now becoming a standard of care in acute ischemic stroke patients with large vessel occlusion. A close cooperation among the departments of emergency, neurology, and neurointervention is needed to improve the quality of life of the patients with large vessel occlusion. Although the concept of time window to send the patients to thrombectomy is recently changed after the two recent trials, including DAWN and DEFUSE 3 trials, there is no debate on the biologic effect of time on neurons damage after a vascular occlusion. In this lecture, the changes on the AHA/ASA 2018 guidelines for the early management of patients with acute ischemic stroke will be discussed. Also, the factors to select the patients for mechanical thrombectomy and their importance will be discussed. Among them are pre-stroke morbidity, infarct core, Alberta stroke program early computed tomography score (ASPECTS), collaterals, location of clot, perfusion, time, age, and National Institutes of Health Stroke Scale (NIHSS) score. The topics that are still missing on the clinical stroke researches will also be discussed, including the role of thrombectomy in posterior circulation occlusion, general anesthesia vs. conscious sedation, aspiration vs. stent retrievers, use of balloon guiding catheter, bridging vs. direct mechanical intervention, workflow and system of care, and imaging selection (CT or MRI, perfusion imaging, collaterals).