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Title: Endovascular Treatment of Acute Ischemic Stroke.
Austin Authors: Maingard, Julian T;Foo, Michelle ;Chandra, Ronil V;Leslie-Mazwi, Thabele M
Affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
School of Medicine, Deakin University, Geelong, Victoria, Australia
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
Faculty of Medicine, Nursing and Heath Sciences, Monash University, Clayton, Victoria, Australia
Issue Date: 11-Dec-2019
Date: 2019-12-11
Publication information: Current treatment options in cardiovascular medicine 2019; 21(12): 89
Abstract: Endovascular thrombectomy (ET), the standard of treatment for emergent large vessel occlusion (ELVO) strokes, has been subject to rigorous efforts to further improve its usage and delivery for optimised patient outcomes. This review aims to provide an outline and discussion about the recently established and emerging recommendations regarding endovascular treatment of stroke. The indications for ET have expanded continually, with perfusion imaging now enabling selection of patients presenting 6-24 h after last-known-well, and improved device and operator proficiency allowing treatment of M2-MCA occlusions and tandem occlusions. Further inclusion of paediatric patients and patients with larger infarct core or milder stroke symptoms for ET has been proposed; however, this remains unproven. This growing applicability is supported by more efficient systems of care, employing modern techniques such as telemedicine, mobile stroke units and helicopter medical services. Ongoing debate exists regarding thrombolytic agent, thrombectomy technique, anaesthesia method and the role of advanced neuroimaging, with upcoming RCTs expected to provide clarification. The journey to further improving the efficacy of ET has advanced and diversified rapidly over recent years, involving improved patient selection, increased utility of advanced neuroimaging and ongoing device redevelopment, within the setting of more efficient, streamlined systems of care. This dynamic and ongoing influx of evidence-based refinements is key to further optimising outcomes for ELVO patients.
DOI: 10.1007/s11936-019-0781-9
ORCID: 0000-0001-8958-2411
Journal: Current treatment options in cardiovascular medicine
PubMed URL: 31823080
ISSN: 1092-8464
Type: Journal Article
Subjects: Endovascular procedures
Interventional neuroradiology
Appears in Collections:Journal articles

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