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Title: Current evidence for endovascular therapy in stroke and remaining uncertainties
Austin Authors: Motyer, Ronan;Asadi, Hamed ;Thornton, John;Nicholson, Patrick;Kok, Hong Kuan
Affiliation: Interventional Neuroradiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland
Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia
School of Medicine - Faculty of Health, Deakin University, Waurn Ponds, Australia
Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
Issue Date: Jan-2018 2017-07-20
Publication information: Journal of Internal Medicine 2018; 283(1): 2-15
Abstract: Class 1 level A evidence now supports endovascular thrombectomy as best practice in the management of large vessel occlusion acute ischemic stroke. However, significant questions pertaining to initial imaging, radiological assessment, patient selection and therapeutic limits remain unanswered. A specific cohort of patients who benefit from endovascular thrombectomy has been established, although current uncertainties regarding selection of those not meeting top-tier evidence criteria may potentially deny certain patients the benefit of intervention. This is of particular relevance in patients presenting in a delayed manner. While superior outcomes are achieved with reduced time to endovascular reperfusion, denying certain patients intervention based on symptom duration alone may not be appropriate. Advanced understanding of ischemic stroke pathophysiology supports an individualized approach to patient evaluation, given variance in the rate of ischemic core progression and the extent of salvageable penumbra. Physiological imaging techniques may therefore be utilized to better inform patient selection for endovascular thrombectomy and evidence suggests that a transition from time-based to tissue-based therapeutic thresholds may be of greater value. Multiple ongoing randomized controlled trials aim to further define the benefit of endovascular thrombectomy and it is hoped that these results will advance, and possibly broaden, patient selection criteria to ensure that maximum benefit from the intervention may be achieved.
DOI: 10.1111/joim.12653
PubMed URL:
Type: Journal Article
Subjects: Endovascular
Interventional Neuroradiology
Ischemia Reperfusion
Appears in Collections:Journal articles

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