Advances in Interventional Neuroradiology 2006

Abstract

Although the traditional use of intravenous (IV) thrombolytics is restricted to within 3 hours of stroke onset, the use of intra-arterial (IA) therapy is proving to be more flexible, with the ultimate time window yet to be determined. Anecdotal evidence suggests that thrombectomy may be effective beyond the 6-hour window in properly selected patients.1 Clinical success and the incidence of complications may be more dependent on the results of perfusion-imaging and the presence of large-vessel occlusion and less on an arbitrary time window. Multimodality strategies are becoming more popular. A combination of mechanical clot retrieval and adjunctive thrombolytic therapies in 111 patients participating in the Multi MERCI trial resulted in successful recanalization in 69% of vessels versus 54% with the retriever alone.2 The preliminary results of the IMS II trial indicate that the MicroLysus ultrasound device (EKOS Corp) may improve recanalization rates compared with standard microcatheter techniques.3,4 Multimodal therapy combining IV or IA abciximab and intracranial angioplasty has been reported to achieve high recanalization rates,5 and preliminary experience with intracranial stenting in acute stroke suggests that this may be an attractive adjunct to IA thrombolytics.6,7 A retrospective review of 168 patients treated with a combination of IA thrombolytics and mechanical interventions reported recanalization in 63% and improvement in NIHSS of at least 4 points in 21% of patients at 24-hour follow-up,8 with the highest recanalization rates seen in patients in whom 3 or more IA modalities …