Mechanical Embolectomy Research Articles

Stroke and Other Cerebrovascular Diseases

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. This review contains 7 figures, 9 tables, and 84 references. Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy

Stroke and Other Cerebrovascular Diseases

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. This review contains 7 figures, 9 tables, and 84 references. Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy

Stroke and Other Cerebrovascular Diseases

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. This review contains 7 figures, 9 tables, and 84 references. Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy

Stroke and Other Cerebrovascular Diseases

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. This review contains 7 figures, 9 tables, and 84 references. Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy

Stroke and Other Cerebrovascular Diseases

Stroke is a leading cause of neurologic morbidity and mortality, and rapid treatment is key for a good outcome. This review addresses the epidemiology, common presenting symptoms, causes, and treatment of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Current recommendations for the emergent evaluation and treatment of an acute ischemic stroke are highlighted, including recently updated indications and contraindications for intravenous recombinant tissue plasminogen activator administration and recent guidelines for the expanded role of endovascular mechanical embolectomy for stroke due to acute large vessel occlusion. An algorithm of diagnostic evaluations to assist with identification of the cause of ischemic stroke is offered. Evidence-based primary and secondary stroke prevention is discussed, including the ideal choice of antithrombotic based on identified stroke mechanism and optimal risk factor management. Best practice supportive measures for the post-stroke patient are highlighted, including recent guidelines for the management of elevated intracranial pressure. Management of uncommon causes of ischemic stroke is also addressed. This review contains 7 figures, 9 tables, and 84 references. Key Words:Intracerebral hemorrhage, ischemic stroke, recombinant tissue plasminogen activator, subarachnoid hemorrhage, antiplatelet therapy, endovascular therapy

Assessment of Blood Clot Composition by Spectral Optical Coherence Tomography: An In Vitro Study.

PurposeOptical coherence tomography (OCT) has the potential for in vivo clot composition characterization in difficult mechanical embolectomy cases. We performed an in vitro study to determine the OCT characteristics of red blood cells (RBCs) and fibrin rich clots.Materials and MethodsAnalogues of 5 compositions of clots (5% to 95% RBCs from Group A to E) were created from human blood. The blood mixture was injected into the bifurcation of a 3D printed bifurcated silicone tube. The OPTISTM Integrated System (St. Jude Medical Inc.) was used to identify the magnitude of OCT signals from different compositions of clots. Martius Scarlett Blue trichrome (MSB) staining was performed to confirm the composition of RBCs and fibrin in each clot.ResultsGroup A and B showed less signal attenuation (less than 30%) from its surface to the inside, which indicated high penetration (low-back scattering). Group C indicated intermediate signal attenuation (60%) from its surface to inside the clots, in which signals were found even at the periphery of the clot. Group D and E were superficially signal rich with more signal attenuation (more than 80%) from its surface to the inside indicating low penetration (high-back scattering). Signal-free shadowing was shown in 3 clots in Group E. MSB staining indicated color change (from red in fibrin-rich clots to yellow in RBC-rich clots).ConclusionDifferent compositions of clots can be assessed using OCT. Fibrin-rich clots have homogeneous signals with high penetration, while RBC-rich clots can be recognized as superficially signal rich with low penetration.

Expanding the stroke team to include interventional cardiology.

Team-based care has been emphasized as a strategy to improve and optimize outcomes for broad groups of patients who have presented with often complex medical conditions including large vessel cerebral occlusion. Although neurointerventionalists from different specialties perform mechanical embolectomy, which has become the standard of care for large vessel cerebral occlusion, these specialties are limited by relatively low numbers typically concentrated in a small number of sites. In this single center experience, approximately 50 patients with large vessel stroke were transferred out of an emergency room to other centers despite the availability of an experienced cardiologist with extensive carotid experience. Such transfer strategies typically result in delays in receiving reperfusion and, therefore, may decrease the success rates and substantial improvement that can be obtained by patients in this setting. Trained interventional cardiologists in centers with limited 24/7/365 coverage could achieve rapid revascularization and reperfusion saving lives. In order to accommodate the need for treating these patients, carotid stent trained cardiologists should enter the arena, learn mechanical embolectomy, and be supported by their colleagues from other disciplines on acute stroke care teams.

EkoSonic® endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes

ABSTRACT Introduction Studies performed in the past decade suggested that evolving reperfusion strategies may improve early outcomes of patients with acute pulmonary embolism (PE) and hemodynamic decompensation. In this regard, catheter-directed treatment (CDT) options are receiving increasing attention. Areas covered A broad spectrum of CDT options exists for the treatment of patients with acute PE. Procedures include catheter-directed local thrombolysis with or without ultrasound assistance, catheter-directed mechanical or suction embolectomy, and combined pharmaco-mechanical approaches. We present here an overview of the available CDT techniques, focusing on the EkoSonic® endovascular system. Expert commentary CDT, particularly local ultrasound accelerated thrombolysis, continues to evolve. Its increasing popularity is the result of accumulating promising results, which suggest a relief of right ventricular (RV) pressure overload and improvement of RV function. These favorable effects on surrogate endpoints were accompanied by a low rate of procedure-related adverse events, notably intracranial hemorrhage. Although the overall risk of serious bleeding appears to be low in CDT, the lack of direct comparisons with other reperfusion options does not allow definitive conclusions. Prospective controlled trials with robust clinical outcomes are urgently needed to establish the postulated benefits of CDT in selected patients with acute PE.

Advanced therapies for pulmonary embolism.

Treatment options for managing patients with acute pulmonary embolism are rapidly evolving. In this review, we discuss the supporting evidence and implementation strategies for these advanced therapeutic modalities. We review the recent data supporting systemic and catheter directed thrombolytic therapies, mechanical embolectomy, use of extracorporeal membrane oxygen support, and pulmonary embolism response teams in managing patients with acute pulmonary embolism. We discuss the major professional society recommendations regarding their implementation. A review of advanced therapies for pulmonary embolism.

Streptococcus Agalactiae Endocarditis and Melena

Question: A 56 year-old woman with no significant past medical history presented from an outside hospital for evaluation of stroke after administration of intravenous tissue plasminogen activator (tPA) resulted in worsening neurological deficits. The patient underwent emergent mechanical embolectomy, which was successful in attaining reperfusion. Subsequent echocardiogram for workup revealed aortic insufficiency and multiple vegetations on the aortic valve which later grew Streptococcus agalactiae.

Clinical analysis of 16 cases of remedial stent placement after mechanical thrombectomy for acute cerebral infarction

Objective To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction. Methods From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators. Results After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection). Conclusion After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect. Key words: Acute ischemic stroke; Stent implantation; Remedial treatment; Mechanical thrombectomy

Abstract TMP1: Predicting Scale Design and Derivation to Select Acute Ischemic Stroke Patients for Direct Angiosuite Intervention

Introduction: Vascular imaging after head CT to confirm large vessel occlusion (LVO) for acute stroke patients requires additional time and delays recanalization. We developed the T hrombectomy A cute M echanical re P erfusion A ssessment ( TAMPA ) scale for selecting patients with LVO for direct angiosuite transfer and intervention to improve recanalization time. Methods: The TAMPA scale was developed from our prospectively collected “Get with the Guidelines” database. We included all “stroke alert” patients between 1/2017 and 8/2018 with vascular imaging and National Institutes of Health Stroke Scale scores between 5 and 25. We excluded patients with immediately obvious non-stroke diagnoses, those lacking subsequent vascular imaging, or those with incomplete records. Different variables were collected. The TAMPA scale receiver operating characteristics curve (ROC) was compared with the ROCs of other commonly used scales. Results: 571 eligible patients from 2115 “acute stroke alerts” were identified for developing the TAMPA scale. The scale was established with a combination of 5 items with a total score of 9: CT hyperdense sign, parenchymal hypodensity, lateralizing hemiparalysis, gaze deviation and speech disturbance. A cutoff of ≥ 4 yielded a sensitivity of 68.98%, specificity of 72.91%, false positive rate of 27.09%, and false negative rate of 31.02%. Compared with other scales, such as total NIHSS, C-stat/CPSSS, RACE, FAST-ED and 3I-SS, the TAMPA scale had the best ROC for the selected group of patients. Conclusions: The TAMPA scale accurately predicts presence of clinically amenable LVO in patients with moderate to severe ischemic stroke. Use of the TAMPA scale to identify high probability mechanical embolectomy candidates for direct transfer to the angiosuite could potentially reduce revascularization times and increase treatment rates.

Catheter-directed therapy for acute pulmonary embolism: navigating gaps in the evidence.

Systemic thrombolysis for acute pulmonary embolism (PE) reduces the risk of death and cardiovascular collapse but is associated with an increased rate of bleeding. The desire to minimize the risk of bleeding events has driven the development of catheter-based strategies for pulmonary reperfusion in PE. These catheter-based strategies utilize lower-dose fibrinolytic regimens or purely mechanical techniques to expedite removal of the embolus. Several devices providing mechanical or suction embolectomy and catheter-directed thrombolysis, with or without facilitation by ultrasound, have been tested. Data are inconsistent regarding the efficacy and safety of mechanical and suction embolectomy. The most comprehensive data on catheter-based techniques stem from trials of ultrasound-facilitated catheter fibrinolysis. Ultrasound-facilitated catheter fibrinolysis relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial haemorrhage than historical rates with systemic fibrinolysis. However, further research is required to determine the optimal application of ultrasound-facilitated catheter fibrinolysis and other catheter-based therapies in patients with acute PE.

Management of Cerebral Vein Thrombosis in a Canadian Tertiary Hospital

Introduction: Cerebral vein thrombosis (CVT) is an uncommon cause of stroke and is more likely to affect young adults and children. Women have a three-fold increased risk compared to men, owing to gender specific factors such as oral contraceptive use (OCP), pregnancy, and hormone replacement therapies. The presenting symptoms of CVT are non-specific and include headache, seizure, focal neurological deficits, or coma as the most severe presentation. The rarity and variable symptoms of the disease leads to delayed diagnosis and implementation of treatment. With improved imaging techniques and increased awareness in recent years, CVT is now more often recognized.Aim: To evaluate patients admitted to The Ottawa Hospital with diagnosis of CVT including demographics, symptoms at presentation, risk factors for CVT, management practices during hospital stay, and discharge disposition. Where available, 12-month follow-up information is provided.Methods: A retrospective chart review of patients admitted to The Ottawa Hospital with diagnosis of CVT between January 2010 - December 2017. Patients were identified using ICD-10 codes from the Ottawa Hospital Data Warehouse.Results: 123 patients were identified in the Data Warehouse and manual chart review confirmed 61 patients diagnosed with CVT. The mean age was 46 years, and 44 (72%) were women. The average hospital stay was 10 days (range 1-66 days) and 25 patients (40%) were admitted to a monitored setting during hospitalization. Only 4 patients had prior history of venous thrombosis. 38 patients (62%) had provoking risk factors for CVT including: surgery (n=6); cancer (5); pregnancy/peripartum (5); oral contraceptive use (21); the remaining 23 patients were unprovoked CVT events. Imaging findings at diagnosis showed 17 patients (28%) had intracranial hemorrhage such as subarachnoid hemorrhage and intraparenchymal bleeding; 17 (28%) had infarction; and 13 (21%) had cerebral edema.All patients received parenteral anticoagulation at time of CVT diagnosis: 54 (89%) with IV unfractionated heparin and the remainder received low molecular weight heparins. One patient received catheter directed thrombolysis, one patient had mechanical embolectomy, two patients underwent decompressive craniectomy, and one patient had both catheter directed thrombolysis and decompression surgery. Four patients died during hospital stay, one directly related to CVT and another due to anticoagulation associated intracranial hemorrhage. More than half of patients were started on warfarin at the time of hospital discharge and no patients were discharged on direct oral anticoagulants (DOACs). 48 patients (79%) were discharged home, 7 (12%) were discharged to rehabilitation programs, and 1 patient (2%) required transfer to nursing home facility. During 12-month follow-up 45 patients (74%) had been transitioned to warfarin and 3 (5%) were on DOACs.Summary: In this cohort of patients admitted with CVT to a large Canadian academic hospital, many were young women and were related to hormonal therapies or peripartum state. All patients received parenteral anticoagulation in hospital and warfarin was the most common oral anticoagulant prescribed. Patients with severe CVT required invasive intervention, with two deaths attributed to CVT or complications from anticoagulation. Most patients returned home within 12-months of discharge from hospital. DisclosuresCastellucci:LEO Pharma: Honoraria; Aspen: Honoraria; BI: Honoraria; Sanofi: Honoraria; Bayer: Honoraria; BMS/Pfizer: Honoraria.

Application of early enteral nutrition combined with supplementary parenteral nutrition in acute ischemic stroke elderly patients with mechanical embolectomy

Objective To explore the effects of early enteral nutrition (EEN) combined with supplementary parenteral nutrition (SPN) in acute ischemic stroke elderly patients after mechanical embolectomy. Methods From October 2015 to June 2017, we retrospectively collected 35 acute ischemic stroke elderly patients treated with nutritional support after mechanical embolectomy. All of the patients were divided into alone EEN group (n=9) and EEN+SPN group (n=26) according to whether to accept SPN or not. We analyzed the clinical data and curative effects, and summarized nutritional monitoring indexes such as the hemoglobin (HGB) , total protein (TP) , total lymphocyte count (TLC) , serum albumin (ALB) before and one, two weeks after surgery and compared the incidence of complications such as pulmonary infection, diarrhea, gastrointestinal hemorrhage as well as average hospital day, hospitalization expenses, outcome of disease. Results There were 24 patients who were cured and discharged from hospital and two patients who were fatal in EEN+SPN group. There were 9 patients who were cured and discharged from hospital. There was no significant difference in HGB, TP, TLC, ALB between two groups before and after surgery (P>0.05) . The difference in ALB of EEN group two weeks after surgery was significant which was compared with that before surgery (P 0.05) . There was no significant difference in average hospital day and hospitalization expenses between EEN+SPN group [ (22.94±12.91) d, (12.53±4.98) ten thousand yuan, respectively]and EEN group (P>0.05) . Conclusions The application of alone EEN in acute ischemic stroke elderly patients after mechanical embolectomy may easily cause that the level of ALB decreases. The EEN+SPN may be applied according to patient's condition so as to prevent hypoproteinemia and improve the nutritional state. Key words: Aged; Stroke; Enteral nutrition; Supplementary parenteral nutrition; Mechanical embolectomy

A Case of Internal Carotid Artery Occlusion resulted in Neurological Recovery by Mechanical Embolectomy after 18 Hours from the Onset

A Case of Internal Carotid Artery Occlusion resulted in Neurological Recovery by Mechanical Embolectomy after 18 Hours from the Onset

Endovascular Mechanical Embolectomy for Acute Middle Cerebral Artery Occlusion Following Recent Cardiac Surgery

Endovascular Mechanical Embolectomy for Acute Middle Cerebral Artery Occlusion Following Recent Cardiac Surgery

Variability of stroke patients meeting endovascular stroke trial criteria in a non-clinical trial setting

BackgroundFive randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke within 8hours used differing radiological methods to select patients. We aimed to evaluate the proportion of patients in clinical practice that would meet radiological criteria for inclusion in these trials. MethodsRetrospective study of ischemic stroke patients at a large academic medical center who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion from April 2010–November 2014. All patients underwent computed tomography (CT) perfusion and CT angiogram. ResultsOf 119 patients, median age was 69 years (IQR 57–79) and median NIHSS 18 (IQR 14–21). Most patients had ASPECTS≥6 (n=105, 88.2%). All 119 patients met radiological criteria for MR CLEAN while 105 (88.2%) met criteria for SWIFT-PRIME, 96 (80.7%) for REVASCAT, 80/116 (69.0%) for EXTEND-IA, and 74 (62.2%) for ESCAPE. About half (n=58,48.7%) were treated with IV rtPA and 66 (56%) underwent endovascular therapy. Any intracranial hemorrhage was more common in patients undergoing endovascular therapy than in those who were not (36% vs. 17%, P=0.034). The frequency of symptomatic intracranial hemorrhage (ICH) did not significantly differ between these groups (6% vs. 4%, P=0.691). ConclusionsThe proportion of patients with acute stroke and large vessel occlusion presenting within 8 hours that would meet radiological criteria for endovascular stroke trials varies considerably (62–100%) in a cohort outside of clinical trials from an academic comprehensive stroke center. Thus, the radiological criteria used for candidate selection in daily practice will greatly influence the proportion of patients treated with endovascular therapy.

Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods.

Rationale Efficacy of mechanical thrombectomy for acute stroke due to large vessel occlusion initiated beyond 6 h of time last seen well has not been demonstrated in randomized trials. Aim To establish whether subjects considered to have substantial areas of salvageable brain based on age-adjusted clinical core mismatch who can undergo endovascular treatment within 6-24 h from time last seen well (TLSW) have better outcomes at three months compared to subjects treated with standard medical therapy alone. Age-adjusted clinical core mismatch is defined by age (≤80 or >80 years), baseline National Institutes of Health Stroke Scale (NIHSS) (10-20 or ≥21), and core size (0-20 cm3 in subjects older than 80 and, in subjects younger than 80, 0-30 cm3 with NIHSS 10-20 and 31-50 cm3 with NIHSS ≥21). Design Prospective, randomized, multicenter, Bayesian adaptive-enrichment, open label trial with blinded endpoint assessment. For the purpose of enrolment, ischemic core size will be evaluated by CT perfusion or magnetic resonance imaging-diffusion-weighted imaging measured by automated software (RAPID). Procedures Subjects with acute ischemic stroke due to computed tomography angiography- or magnetic resonance angiogram-proven arterial occlusion of the intracranial internal carotid and/or proximal middle cerebral artery (M1) with age-adjusted clinical core mismatch in whom treatment can be initiated between 6 and 24 h from TSLW are randomized in a 1:1 ratio to receive mechanical embolectomy with the Trevo device or medical management alone. Sequential interim analyses allowing adaptation of enrolment criteria or stopping new enrolment for futility or predicted success will occur in every 50 randomized patients starting at 150 to a maximum of 500 patients. Study outcomes The primary endpoint is the modified Rankin Scale score at 90 days. The primary safety outcome is stroke-related mortality at 90 days. Analysis The primary endpoint, expressed as a utility-weighted modified Rankin Scale score is analyzed using a Bayesian posterior probability with adjustment for ischemic core size. For regulatory reasons, a nested co-primary endpoint analysis was added consisting of the proportion of subjects with modified Rankin Scale 0-2 between the active and control groups also analyzed using a Bayesian model.

The management of acute ischemic stroke - a role for percutaneous intervention?

Acute ischemic stroke due to large vessel occlusion is a devastating disease. In the vast majority of cases little is done to reverse the actual cause, and that is to open the occluded artery. This article reviews the current standard management with intravenous thrombolysis and highlights some of its limitations, and the more recent development of mechanical embolectomy for the emergency treatment of ischemic stroke.