Introduction: Intravenous fibrinolysis is the only proven treatment for acute ischemic stroke (AIS), but a limited therapeutic time window and risk of systemic hemorrhagic limit its real-world effectiveness. Minimally invasive endovascular therapies may provide opportunities to expand the AIS treatment window and enhance clinical outcomes.
Areas covered: Current and future endovascular techniques that aim to address the hemodynamic, neuroanatomic and neurovascular complexities of acute cerebral ischemia are discussed. Scales for measuring relevant angiographic and clinical end points are also covered. Procedural timing and optimal patient selection using various imaging modalities are mentioned. Previous and ongoing clinical trials in AIS are discussed as well as emerging approaches.
Expert opinion: Endovascular therapy has opened up new horizons for treatment of AIS. It offers multiple new and promising therapeutic approaches that are not limited to one specific device or method, but could conceivably be additive and also individualized based upon each patient's characteristics.