Evidence and Patient Selection for Endovascular Reperfusion Therapy for Acute Ischemic Stroke:A Narrative Review

Abstract

Three former stroke trials failed to show the efficacy of endovascular stroke reperfusion therapy using intra-arterial thrombolysis or older-generation mechanical thrombectomy devices, compared with usual medical care in 2013. However, five pivotal trials in 2015(MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT), using newer-generation devices(e.g., stent retrievers), have shown stroke thrombectomy to clearly improve the functional outcome of patients with occlusion of the internal carotid artery or the M1 portion of the middle cerebral artery(baseline National Institutes of Health Stroke Scale score ≥ 6; baseline Alberta Stroke Program Early Computed Tomography Score ≥ 6), and who could receive thrombectomy within 6 h of symptom onset . In 2018, the efficacy of stroke thrombectomy for late-presenting patients with up to 16-24 h of onset and those who had a mismatch between neurological severity and ischemic core volume was also established by the DAWN and DEFUSE 3 trials. In 2022, the efficacies of stroke thrombectomy for patients with a large ischemic core or basilar artery occlusion were identified. This article discusses the evidence and patient selection for endovascular reperfusion therapy for acute ischemic stroke.