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Endovascular Treatment of Stroke Patients

AUTHORS

Joachim Berkefeld 1 , *

1 Leading Physician, Head of Interventional Neuroradiology, Institut fr Neuroradiologie, Klinikum der Goethe-Universitat, Schleusenweg, Frankfurt, Germany

How to Cite: Berkefeld J. Endovascular Treatment of Stroke Patients, Iran J Radiol. Online ahead of Print ; 14(Special Issue):e48402. doi: 10.5812/iranjradiol.48402.

ARTICLE INFORMATION

Iranian Journal of Radiology: 14 (Special Issue); e48402
Published Online: April 12, 2017
Article Type: Abstract
Received: December 20, 2016
Accepted: February 7, 2017
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Abstract

Stroke patients with proximal occlusions of the main stems of cerebral arteries are no optimal candidates for i. v. thrombolysis. For many years interventional stroke treatment could not be established as alternative. This changed with the introduction of stent retrievers and flexible large lumen aspiration catheters. Randomized trials now proved a significant benefit from intervention for a wide spectrum of severely compromised stroke patients in time windows of up to 8 hrs. However, the randomized trials leave open questions concerning proper patient selection. The benefit for patients with larger infarcts with an ASPECTS between 3 and 5 or patients in time windows above 8 hrs is still uncertain. Especially for critical candidates imaging for reliable detection of the ischemic core and surrounding salvageable brain tissue plays an important role. Technically equivalence between new aspiration techniques as alternative to the use of stent-retrievers is not finally proven. Recanalization of tandem occlusions with the necessity of acute stenting demands better materials for plaque coverage and thrombus withhold. Management of cases with occlusions due to intracranial atherosclerosis is also debatable. The positive trial results provide especially new challenges to establish countrywide neurointerventional services. Even in developed countries recruitment and training of interventional radiologists as well as priority transportation of stroke patients is challenging to organize.

Keywords

© 2017, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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