Acute Phase Of Cerebral Infarction Research Articles

Variability in sleep architecture and alterations in circadian rhythms in patients with acute cerebral infarction accompanied by sleep-disordered breathing.

To continuously and dynamically monitor the sleep status of patients in the acute phase of cerebral infarction, and to investigate the characteristics of acute cerebral infarction(ACI)associated with sleep-disordered breathing (SDB), variations in sleep structure, and changes in sleep circadian rhythms. Patients with ACI within 48h of onset who were admitted to the Department of Neurology at Kailuan General Hospital from November 2020 to December 2022 were selected. Detailed baseline information such as age, gender, smoking history, drinking history, were recorded for the selected participants. From the beginning of their hospitalization, the selected participants were monitored for their sleep status continuously for 5 days using the Intelligent Mattress-based Sleep Monitoring Platform System(IMSMPS). Based on the heart rate data obtained from the monitoring, the interdaily stability (IS) and intradaily variability (IV) of the sleep circadian rhythm were calculated. 1,367 patients with ACI were selected. Monitoring results over 5 days indicated 147 cases (10.75%) without SDB, and 1,220 cases (89.25%) with SDB. Among the group with SDB, there were 248 cases (18.14%) with continuous mild SDB, 395 cases (28.90%) with moderate SDB, 295 cases (21.58%) with severe SDB, and 282 cases (20.63%) that fluctuated between different severity levels. Within this fluctuating group, 152 cases (53.90%) fluctuated between two severity levels, 120 cases (42.55%) between three levels, and 10 cases (3.55%) among all four levels. There were statistically significant differences (P < 0.05) in the sleep latency, sleep efficiency, non-rapid eye movement stages 1-2, rapid eye movement, proportion of non-rapid eye movement, proportion of rapid eye movement, wake after sleep onset, time out of bed, number of awakenings, respiratory variability index, and heart rate variability index among patients with ACI monitored from day 1 to 5. However, other monitored sleep structure parameters did not show statistically significant differences (P > 0.05). The coefficient of variation for all sleep monitoring parameters ranged between 14.54 and 36.57%. The IV in the SDB group was higher than in the group without SDB (P < 0.05), and the IS was lower than in the group without SDB (P < 0.05). Patients in the acute phase of cerebral infarction have a high probability of accompanying SDB. The sleep structure of these patients shows significant variability based on the onset time of the stroke, and some patients experience fluctuations among different severity levels of SDB. ACI accompanied by SDB can further reduce the IS of a patient's sleep circadian rhythm and increase its IV.

Lower Melatonin Indicates Poor Short-term Prognosis in Patients with Acute Ischemic Stroke.

We evaluated endogenous melatonin levels in the acute phase of cerebral infarction and explored the impact of possible changes in melatonin levels on the prognosis of patients. This study recruited acute ischemic stroke (AIS) patients from the Department of the Second Affiliated Hospital of Soochow University between December 2019 and June 2021, along with healthy control subjects. Salivary melatonin samples were collected from each participant between 7 pm and 10 pm, and fasting plasma was collected the following morning to measure the levels of inflammatory markers. The prognosis was assessed through follow-up three months after discharge. The relationship between melatonin levels and plasma inflammatory markers was assessed, followed by an analysis of the effect of melatonin levels on patient prognosis. The study enrolled a total of 160 participants, including 120 AIS patients aged 50 years or older (61.7% male) and 40 age-matched controls (55.0% male). The AIS group exhibited lower salivary melatonin levels at 19 (P = 0.002), 20 (P < 0.001), 21 (P < 0.001), and 22 (P < 0.001) o'clock, and the average melatonin level was also lower (P < 0.001). Logistic regression analysis models indicated an association between low melatonin levels and poor prognosis. Salivary melatonin levels demonstrated good predictive ability for the prognosis of AIS patients. Melatonin levels were lower in AIS patients compared to controls. In addition, lower melatonin levels were associated with a poorer prognosis among AIS patients.

Electroacupuncture ameliorates gastrointestinal dysfunction by modulating DMV cholinergic efferent signals to drive the vagus nerve in p-MCAO rats

BackgroundThe use of proton pump inhibitors in the acute phase of cerebral infarction may lead to adverse long-term outcomes, this study aims to explore the potential of electroacupuncture (EA) in replacing omeprazole in exerting post-stroke gastrointestinal protection. MethodsA permanent middle cerebral artery infarction model was established using the modified Longa thread occlusion technique. Gastrointestinal motility, gastrointestinal mucosal damage, cerebral infarct volume, and alterations in choline acetyltransferase (ChAT)-positive neurons within the dorsal motor nucleus of the vagus nerve (DMV) were assessed after 7 days of EA at Zusanli (ST36) or omeprazole intervention. To evaluate the role of the vagal nerve in mitigating post-stroke gastrointestinal dysfunction, we employed subdiaphragmatic vagotomy and the ChAT-specific inhibitor α-NETA. Additionally, we utilized methyllycaconitine (MLA), a selective inhibitor of the α7-type nicotinic acetylcholine receptor (α7nAChR), and PNU282987, an agonist, to identify the target of EA. ResultsEA restored ChAT neurons lost in the DMV, activated the vagus nerve and conferred cerebroprotection while ameliorating gastrointestinal mucosal injury and gastrointestinal motility disorders. In addition, following the administration of the α7nAChR antagonist, the attenuation of gastric mucosal injury and inflammatory factors induced by EA was hindered, although gastrointestinal motility still exhibited improvement. ConclusionEA at ST36 promotes the restoration of cholinergic signaling in the DMV of stroke-afflicted rats, and its excitation of the vagal nerve inhibits gastrointestinal inflammation after stroke via α7nAChR, while improvement in gastrointestinal motility could be mediated by other acetylcholine receptors.

Improving the longitudinal spot width of an optimizingly designed point-like scatterer-arrayed transcranial ultrasonic lens

As a non-invasive therapy to promote the effect of the thrombolytic agent in the acute phase of cerebral infarction, transcranial irradiation by ultrasonic waves at the site of the occlusion has been validated and is expected to achieve clinical application. Such irradiation may, however, cause damage to the brain by interference of reflected waves within the skull. In order to avoid such a phenomenon, we proposed a transcranial acoustic lens formed by optimizing the arrangement of point-like scatterers. The optimum arrangement of scatterers was determined so that the sound field vanishes within the skull except at the focus(es) and becomes higher at the focus(es) than in the surrounding regions. The ultrasonic waves are strongly scattered by air bubbles in the water-like medium, so we attempted to install a crossbar switch in the medium covering the head and constructed an acoustic lens by producing an instantaneously adaptive air bubble array. This lens can focus an incident plane wave to the diffraction limit in the direction perpendicular to the incident direction, while the peak width in the propagation direction is more than five times higher. In this work, in order to practically improve it, we propose to arrange a point-like scatterer so as to partially cover the head and further increase the number of layers. The shape of the skull is modeled based on CT data, and more realistic parameters are employed than in a previous paper [T. Ueta, J. Appl. Phys. 132, 144504 (2022)].

Factors associated with improvement in impaired consciousness during the acute phase of cerebral infarction: a prospective observational study.

[Purpose] In this study, we investigated factors that contribute to improvement in impaired consciousness following cerebral infarction. [Participants and Methods] This prospective observational study included 186 patients with cerebral infarction. We investigated 21 variables including the rehabilitation status to determine factors that contribute to improvement in impaired consciousness. [Results] Improvement in impaired consciousness was correlated with age, delirium, the Japan Coma Scale score at initiation of rehabilitation, worsening, cerebral edema, and standing practice. [Conclusion] We conclude that the aforementioned factors may serve as predictors of possible improvement and that standing practice may contribute to improvement in impaired consciousness.

Distribution of amyloid-β precursor protein-immunoreactive axons differs according to the severity of cerebral ischemia in autopsy brains.

Amyloid-β precursor protein (APP) immunohistochemistry has been used to detect axonal injury in forensic neuropathology. However, axonal injury caused by cerebral ischemia has not been investigated by APP immunohistochemistry in detail. In particular, it is unknown if there is a correlation between the prognosis of cerebral ischemia and the distribution of axonal injury detected by APP immunohistochemistry. To address this issue, we compared the distribution of APP-immunoreactive axons in autopsy brains including lesions of acute phase of cerebral infarction in the territory of the middle cerebral artery (MCA) or internal carotid artery (ICA) with the degree of severity. The presence or absence of a midline shift was used as an indicator of the severity of cerebral ischemia. We identified a difference in the distribution of APP-immunoreactive axons between cases with and without a midline shift. In both the groups, APP-immunoreactive axons were detected at the margin of the ischemic lesions; however, only in cases with a midline shift, intense APP-immunoreactive axons were also found in areas other than the MCA and ICA territories, including the white matter of the cerebral hemispheres ipsilateral and contralateral to the ischemic lesions. This distribution was different from that of acute global cerebral ischemia cases reported previously. Our results indicate that the distribution of APP-immunoreactive axons differs according to the severity and type of cerebral ischemia, suggesting that the distribution of APP-immunoreactive axons is associated with the prognosis of cerebral ischemia.

Effect of masticatory function on central nervous system regeneration in the acute phase of cerebral infarction

Effect of masticatory function on central nervous system regeneration in the acute phase of cerebral infarction

Effect of Rehabilitation Training on the Recovery of Hemiplegic Limb in Patients with Cerebral Infarction

The purpose of this study is to explore the effect of rehabilitation training on limb recovery of patients with cerebral infarction hemiplegia and the improvement of daily life activities of patients. In this study, 46 patients with cerebral infarction hemiplegia are selected as the research subjects. All of them receive rehabilitation training within 0 to 24 h after the acute phase of cerebral infarction and the patient’s vital signs are stable. After rehabilitation training for 2 w and 4 w, the motor function and daily life activity of hemiplegic limbs are evaluated, and the muscle strength recovery of patients is evaluated after rehabilitation training for 2 mo. The results show that after rehabilitation training, the muscle strength of hemiplegic patients with cerebral infarction is obviously restored, and the motor function of hemiplegic limbs and the ability of daily activities are significantly improved. Therefore, it can be concluded that rehabilitation training is conducive to promoting the recovery of limb motor function in patients with cerebral infarction hemiplegia and improving the life ability of patients, which has the promotion value. In the future research, large sample, multi-center randomized clinical control trial should be carried out to provide more reliable and effective rehabilitation mode for limb recovery of patients with cerebral infarction hemiplegia.

Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome.

Intravenous thrombolysis (IVT) improves functional outcome after acute ischemic stroke (AIS) and is the standard first-line treatment; however, it is associated with many complications, including cerebral hemorrhage. Cancer patients are susceptible to thrombotic events – collectively referred to as Trousseau syndrome (TS) – owing to their hypercoagulable state. Here, we describe the case of a 55-year-old male with a history of hypertension for over 10 years who underwent surgery for removal of a cancer of lower esophagus, with no subsequent treatment. Three months later, he was admitted to the emergency department of our hospital with sudden dizziness and incoherent speech. Brain computed tomography revealed multiple cerebral infarctions. The patient was treated by IVT with tissue plasminogen activator (rtPA) after the onset of symptoms, which improved by the end of the treatment. However, a few months later, he experienced a recurrence of cerebral infarction and hemorrhage, which has rarely been reported. The clinical course of this case suggests that the suitability of thrombolysis with rtPA in the acute phase of cerebral infarction complicated with TS should be carefully considered.

Does Intravenous Thrombolysis Influence the Time of Recanalization and Success of Mechanical Thrombectomy during the Acute Phase of Cerebral Infarction?

Objectives: Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. Recanalization time is a key factor in the treatment of AIS. It has previously been suggested that intravenous thrombolysis (IVT) may be associated with a shorter recanalization time. The aim of our study was to investigate whether IVT or other factors could be associated with shorter or longer MT procedure times. Methods: We performed a retrospective analysis of a local cohort of patients treated by MT. We collected procedure time (puncture to recanalization and clot visualization to recanalization), demographic data, localization of the thrombus, antithrombotic treatment at arrival, IVT infusion, and stroke subtype at discharge according to the TOAST classification. We planned to analyze the full cohort and the successful revascularization subgroup. Results: There was no difference in procedure times between patients who received IVT and those who did not. In the successful revascularization subgroup, patients presenting with cardioembolic stroke had a significantly shorter time between clot visualizations and revascularization than the other patients (41 vs. 56 min, p = 0.024), but this was not the case in the full cohort. Also in the successful revascularization subgroup, the revascularization time was 76 vs. 61 min (p = 0.075) in patients presenting with tandem occlusion vs. the others, but there was no difference between these groups in the full cohort. Conclusions: There was no difference in terms of procedure times in patients treated by IVT and MT vs. patients treated by MT alone either in the full cohort or in the successful revascularization subgroup. The data from the successful revascularization subgroup may be useful for studying revascularization times, provided that data from procedures that were stopped prematurely by the operator due to the length of time since symptom onset is removed.

Results of Therapy Using Oral Anticoagulants in the Acute Phase after Mechanical Thrombectomy.

The usage of oral anticoagulants (OACs) in the acute phase of cerebral infarction has increased, but the optimal timing for starting OACs after mechanical thrombectomy (MT) is unclear. We report the usage of OACs after MT at our hospital and evaluated the outcomes. OACs were selected as secondary preventive drugs for 64 patients who underwent MT for anterior circulatory embolism between July 2016 and January 2019. Of the 64 patients, 28 and 36 received direct oral anticoagulants (DOACs) and warfarin (Wf), respectively. We compared the frequency of intracranial hemorrhage in the acute phase and that of recurrent cerebral infarction within 30 days. The median diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Scores + white matter (DWI-ASPECTS + W) score at admission was 7.5 (IQR 6-9)/8 (IQR, 6-9) in the DOACs group/Wf group. The rate of recanalization with modified thrombolysis in cerebral infarction (TICI) ≥2B by MT was 89.3/80.6%. In patients with subarachnoid hemorrhage (SAH) associated with MT and patients with hemorrhagic transformation (HT) on MRI the next day, administration was started after hemostasis. The median timing of the first anticoagulant administration was 3 (IQR, 2-4)/2 (IQR, 1-4) days. In the case of no HT the next day, the rate of new HT after 1 week was 7.1%/29.1%. In the case of HT the next day, the rate of HT deterioration the next day was 7.1%/16.6%. The percentage of symptomatic bleeding was 0%/2.8%. The percentage of recurrent cerebral infarction within 30 days was 0%/2.8%. OACs in the acute phase after MT can be safely used and are expected to be effective at preventing recurrence.

Impact of Verticalization on Intracranial Hemodynamics Assessed in Transcranial Doppler at the Acute Phase of Cerebral Infarction

Impact of Verticalization on Intracranial Hemodynamics Assessed in Transcranial Doppler at the Acute Phase of Cerebral Infarction

Effects of major ozonated autoheamotherapy on functional recovery, ischemic brain tissue apoptosis and oxygen free radical damage in the rat model of cerebral ischemia.

Stroke is the second leading cause of death and disability in the world, with a heavy burden on patients, their families, and society. At present, a major focus of cerebrovascular disease research is to find a safe and effective new method to promote early functional recovery in the acute phase of cerebral infarction. Major ozonated autohemotherapy (MOAH) can maintain ATP and energy metabolism in cerebral ischemia and hypoxia, and reduce cell apoptosis. In the current study, the model of middle cerebral artery occlusion in the Sprague Dawley rat was established and evaluated by the clinical functional score, Hoechst staining, immunohistochemistry, Western blot analysis, and biochemical detection. Then, the effects of MOAH on neurological function, apoptosis, and oxygen free radical damage after acute ischemia in middle cerebral artery were evaluated. Moreover, the potential two mechanisms have been illustrated for MOAH effects. This study would lay a theoretical foundation for the application of MOAH and find an effective and early treatment method for the cerebral infarction.

Correlation between cognitive impairment during the acute phase of first cerebral infarction and development of long-term pseudobulbar affect.

PurposeThe relationship between cognitive impairment during the acute phase of first cerebral infarction and the development of long-term pseudobulbar affect (PBA) has not been elucidated. Therefore, in this study, we aimed to determine if cognitive impairment during the acute phase of cerebral infarction will increase the risk of long-term post-infarction PBA.Patients and methodsThis was a nested case–control study using a prospective approach. A consecutive multicenter matched 1:1 case–control study of cognitive impairment cases following acute cerebral infarction (N=26) with 26 sex-, education years-, and age-matched controls. Univariate and multivariate conditional logistic regression analyses were performed to study the clinical features and changes in cognitive domain as well as the risk factors for PBA.ResultsLong-term PBA was independently predicted by low Montreal cognitive assessment (MoCA) scores at baseline. Multivariable regression models showed that post-infarction low MoCA scores remained independent predictors of long-term PBA (odds ratio [OR]=0.72; 95% confidence interval [CI]=0.54–0.95; P=0.018). Among all cognitive disorders, digit span test (DST) scores (OR=0.39; 95% CI=0.16–0.91, P=0.030), StroopC time (OR=1.15; 95% CI=1.01–1.31; P=0.037), and clock-drawing task (CDT) scores (OR=0.62; 95% CI=0.42–0.90; P=0.013) were found to be the independent risk factors for PBA.ConclusionCognitive impairment during the acute phase of cerebral infarction increased the risk of cerebral infarction-induced long-term PBA. Development of PBA was closely associated with executive function, attention, and visuospatial disorder.

No Association between Elevated Total Homocysteine Levels and Functional Outcome in Elderly Patients with Acute Cerebral Infarction.

Background: An elevated plasma total homocysteine (tHcy) level is an independent risk factor for vascular events. The aim of the present study was to investigate the association between tHcy levels in the acute phase of cerebral infarction and functional outcome among elderly patients.Methods: Between October 2009 and December 2012, we recruited 594 elderly patients (age > 75) with first-onset acute cerebral infarction who were consecutively admitted to the Department of Neurology of Tianjin Huanhu Hospital, China. Levels of tHcy and other biochemical values were measured within 24 h after admission. tHcy values were classified according to quartiles (<9.94; 9.94 to <12.7; 12.7 to <16.8; and ≥16.8 μmol/L). We examined the relationship between tHcy levels at admission and modified Rankin Scale scores (mRS) using univariate and multivariate analyses. Patients were followed up at 3 months and 1 year after stroke.Results: Within 3 months after stroke, 64 patients died, 37 had recurrent ischemic stroke, and 22 were lost to follow-up; thus, 471 patients were reviewed and analyzed. By the time of the 1-year follow-up, an additional 48 patients had died, 44 had recurrent ischemic stroke, and 40 had been lost to follow-up; the remaining 339 patients were thus reviewed and analyzed. Elevated tHcy levels were not associated with functional outcome among elderly patients with acute cerebral infarction (p > 0.05). Only the National Institutes of Health Stroke Scale score was associated with a poor outcome after adjusting for confounders at 3 months and 1 year (adjusted odds ratio, 1.38; 95% CI, 1.28–1.49; p < 0.01; adjusted odds ratio, 1.34; 95% CI, 1.25–1.44; p < 0.01, respectively).Conclusion: Among elderly patients with acute cerebral infarction, elevated tHcy at admission was not a predictive factor of outcome at 3 months and 1 year after stroke onset.

Clinical Correlation between Plasma D-Dimer Level and Long-Term Neurological Outcome in Acute Ischemic Stroke

Background: D-dimer is a reliable and sensitive index of fibrin deposition and stabilization. It is well known that D-dimer levels are sig nificantly associated with cardioembolic infarction and are elevated during the acute phase of cerebral infarction. Several studies also suggest a possible role of D-dimer in the early prognosis of ischemic stroke. However, it is controversial whether D-dimer can also predict the long-term outcome following ischemic stroke. Therefore, the purpose of this study is to investigate the effect of plasma D-dimer level at admission on long-term functional outcome after ischemic stroke. Methods: We recruited 246 patients with acute ischemic stroke. All subjects had their plasma D-dimer levels evaluated and checked by the modified Rankin scale (mRS) at discharge and at follow-up visits at 3 months, 6 months, and 9 months later. All subjects were divided into 4 groups according to mRS (mRS ≤2 vs mRS ≥3) and plasma D-dimer level (< 0.5 µg/ml vs ≥0.5 µg/ml) to investigate the relationship between plasma D-dimer levels and long-term functional outcome in patients with acute ischemic stroke. Results: There are no significant differences of age, gender and stroke risk factors among the 4 groups. The two patient groups with mRS ≥3 showed significant differences according to their plasma D-dimer levels. On the other hand, the two patient groups with mRS≤2 showed no significant differences according to their plasma D-dimer levels. Conclusion: We assume through this study that D-dimer levels play a role in long-term functional neurological outcome in ischemic stroke with severe neurological deficit. However, to clarify the role of D-dimer in stroke, future longitudinal studies involving a large co hort are required. J Neurocrit Care 2015;8(2):85-90

Hemorrhagic Transformation in Patients with Cerebral Infarction Referred to a Rehabilitation Hospital

Purpose: The aim of our study was to investigate the presenting conditions of patients with hemorrhagic transformation (HT), the frequency of HT and its treatments at a rehabilitation hospital. Subjects and Methods: 165 patients with cerebral infarctions transferred to our rehabilitation hospital during the study period were enrolled. HT was diagnosed by two stroke specialists using computed tomography (CT) at the time of transfer to our rehabilitation hospital and other imaging data from previous consultations. Neurological status, activities of daily living, administered agents, patient age, duration from stroke onset to transfer and length of hospital stay were examined. Results: 30 of the 165 patients (18.2%) were diagnosed with HT. Decreased activities of daily living at admission and discharge as well as longer hospitalization stays were more prevalent in HT patients than in those without HT. We did not change antiplatelet or anticoagulant agents, but continued rehabilitation over a defined period while monitoring blood pressure; we confirmed with CT that the patients' physical conditions did not deteriorate. Conclusion: With careful symptom and CT monitoring over a defined period, rehabilitation can be continued in patients who develop HT at the time of transfer to a rehabilitation hospital in the acute phase of cerebral infarction.

Technical standards for the interventional treatment of acute ischemic stroke

Acute ischemic stroke is the leading cause of acquired disability and its treatment is still a major challenge. For more than a decade, various mechanical devices have been developed for the recanalization of proximal artery occlusions in acute ischemic stroke but most of them have been approved for clinical use, only on the basis of uncontrolled case series. Intravenous thrombolysis with recombinant tissue-specific plasminogen activator administered (iv rtPA) within 4.5h of symptom onset is so far the only approved medicinal treatment in the acute phase of cerebral infarction. With the introduction of stent retrievers, mechanical thrombectomy has demonstrated substantial rates of partial or complete arterial recanalization and improved outcomes compared with iv rtPA and best medical treatment alone in multiple randomized clinical trials in select patients with acute ischemic stroke and proximal artery occlusions. This review discusses the evolution of endovascular stroke therapy followed by a discussion of the current technical standards of mechanical thrombectomy that have to be considered during endovascular stroke therapy and the updated treatment recommendations of the ESO Karolinska stroke update.

Noninvasive assessment of ischemic penumbra by using MR-SWI during the acute phase of cerebral infarction: a comparison to PWI

Background: Assessment of ischemic penumbra during the acute stage of cerebral infarction is crucial for a decision to initiate thrombolytic therapy and for predicting stroke evolution. Although controversial as a perfect equivalence to penumbra, perfusion weighted imaging (PWI)-diffusion weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance on contrast agents in PWI, noninvasive alternatives remain an unmet need. Methods: We herein investigate the potentials of SWI as an alternative to PWI in defining ischemic penumbra and in predicting stroke outcome. A multimodal magnetic resonance imaging work-up which includes conventional magnetic resonance imaging sequences (T1WI, T2WI and FLAIR), DWI, PWI and SWI was performed. The Alberta Stroke Programme Early CT Score (ASPECTS) was used to evaluate the changes in DWI, SWI and PWI. Results: The mismatch of SWI-DWI was comparable with that of PWI-DWI (p&gt;0.05). Furthermore, the grade of prominent vein and the cerebral blood volume in the ipsilateral brain tissue were positively correlated. Conclusions: SWI can be used as a noninvasive alternative to identify occlusive arteries and to evaluate the ischemic penumbra. The susceptibility vein sign may represent thrombosis in arteries whereby being helpful to identify responsible blood vessels in ischemic stroke.

Endovascular treatment in patients with acute ischemic stroke: Technical aspects and results

Ischemic stroke is the primary cause of acquired disability in the world and its treatment is still a challenge. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) administered within 4½ hours of the onset of the symptoms is the only approved medical treatment in the acute phase of cerebral infarction. However, its efficacy is limited where there is proximal intracranial arterial occlusion, and there are many contraindications. The endovascular approach, combined or not with IV thrombolysis, allows high rates of recanalization to be achieved within a short period of time, with a low rate of procedural complications when thrombolysis is less effective (internal carotid artery, M1 segment of the middle cerebral artery). In these situations, endovascular techniques are playing an increasing role in the treatment of these patients even though there is still no indisputable scientific proof of their efficacy. The priority at present is to finish the French THRACE study, but it is already time to think about the next one.