Frontiers in Neurosurgery

Author(s): Paolo Machi, Kiriakos Lobotesis and Alain Bonafé

DOI: 10.2174/9781681080055115010009

Endovascular Reperfusion Management for Acute Ischemic Stroke

Pp: 139-153 (15)

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Abstract

SHS investigation development is considered from the geographical and historical viewpoint. 3 stages are described. Within Stage 1 the work was carried out in the Department of the Institute of Chemical Physics in Chernogolovka where the scientific discovery had been made. At Stage 2 the interest to SHS arose in different cities and towns of the former USSR. Within Stage 3 SHS entered the international scene. Now SHS processes and products are being studied in more than 50 countries.

Abstract

Early recanalization of a thrombosed cerebral artery in a patient with acute ischemic stroke is related to better outcome and reduced mortality. Intravenous administration of rt-PA within 4.5 hours from stroke onset is the recommended therapy for acute ischemic stroke. However, several studies demonstrated improvements, in terms of anatomical and clinical results when intravenous therapy is associated with intra-arterial approach. Although improvement in outcome of patients treated by mechanical approach reported in various case series, three recent randomized controlled failed to demonstrate the superiority of mechanical thrombectomy over intravenous fibrinolysis. In the first part of this chapter we report the results of these randomized trials and discuss their biases and limitations. We then describe stentriever thrombectomy techniques and the mechanical approach to tandem occlusions.

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