Vascular neurologists and neurointerventionalists on endovascular stroke care

Abstract

Endovascular revascularization therapy is a promising method for treating patients with AIS; however, many challenges remain. The findings from the SVIN roundtable meeting highlight several important points regarding the present state of endovascular therapy and the future direction of the field. Patient selection is essential for the success of endovascular therapy in acute stroke.1 The spectrum of dramatic benefit and failure in endovascular therapy for AIS underscores the importance of identifying markers for those who will be helped and those who will be harmed. Simple rapid imaging such as noncontrast head CT remains fundamental to patient evaluation. However, further study is needed in advanced imaging such as perfusion studies, in order to liberate stroke triage from the constraint of time and reach more patients.2 Furthermore, the triage system for stroke networks, requirements of providing institutions, and guidelines for those trained in neurointerventional procedures need to be better defined.3,4 Stroke intervention techniques vary among neurointerventionalists, which emphasizes the need to identify the optimal revascularization approach. This might include a single or multimodal use of mechanical devices, thrombolytic agents and doses, and adjunctive therapies. Perioperative management also varies, and not all factors that might change outcome are known. The variability in triaging patients, in the neurointerventional technical approach, and in periprocedural management is an indication of the urgent need for consensus, standardization, and additional research to provide evidence to support particular approaches for particular patient populations. The armamentarium available to neurointerventionalists continues to expand, but the optimal design for a revascularization device remains unknown and demands continued innovation. As the young field of endovascular revascularization therapy continues to evolve and patient selection is better defined, education of health care providers and awareness among those in the community will become essential to carry the success of endovascular therapy in the battle against AIS. In these interesting polling questions, participants of the SVIN roundtable meeting addressed each aspect of the care of patients with ischemic stroke as it pertains to endovascular therapy, and their answers may be of interest to readers, policymakers, and researchers alike. However, because of space limitations, only certain polling questions and responses were included in this report, which may limit the ability to understand the full complexity of the system of care for AIS. Moreover, some new areas of clinical care and research may not have been addressed by the polling questions or the roundtable topics. A clinical continuum network of care with a spokes-and-hub model (whether ship-and-drip or retrieve-and-ship to a tertiary stroke center) and research network needs were not brought up in this polling report. We would like to underscore that the current polling report reflects the opinions of the attendees of the SVIN roundtable but is limited in lacking supportive data and sampling errors. Polling different attendees might have produced different responses.