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Semin Neurol 2023; 43(03): 397-407
DOI: 10.1055/s-0043-1771454
Review Article

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Natalia Starikova
1   Department of Neurology, University Clinic of Odessa National Medical University, Odessa, Ukraine
2   TeleHealth Consulting Service, Medical Center “Expert Health,” Odessa, Ukraine
,
Silja Räty
3   Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
,
Daniel Strbian
3   Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
,
Daniel P. O. Kaiser
4   Institute of Neuroradiology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
5   Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
,
Johannes C. Gerber
4   Institute of Neuroradiology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
5   Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
,
Xiaochuan Huo
6   Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
,
Zhongming Qiu
7   Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
,
Hui-Sheng Chen
8   Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
,
Johannes Kaesmacher
9   Interventional Neuroradiology, Bern University Hospital, University of Bern, Bern, Switzerland
,
Lars-Peder Pallesen
5   Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
10   Department of Neurology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
,
Kristian Barlinn
5   Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
10   Department of Neurology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
,
Dapeng Sun
6   Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
,
Mohamad Abdalkader
11   Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
,
Thanh N. Nguyen
11   Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
12   Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
,
Simon Nagel
13   Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
14   Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
,
Zhongrong Miao
6   Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
,
Volker Puetz
5   Dresden Neurovascular Center, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
10   Department of Neurology, University Clinics Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
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Abstract

The last decade's progress in demonstrating the clinical benefit of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke has transformed the paradigm of care for these patients. This review presents the milestones in implementing EVT as standard of care, demonstrates the current state of evidence, provides guidance for identifying the candidate patient for EVT, and highlights unsolved and controversial issues. Ongoing trials investigate broadening of EVT indications for patients who present with large core infarction, adjunctive intra-arterial thrombolysis, medium vessel occlusion, low NIHSS, and tandem occlusion.

Keywords

anterior circulation LVO stroke - mechanical thrombectomy - medium vessel occlusion - large ischemic core - large infarct - outcome - clinical trial


Publication History

Article published online:
07 August 2023

© 2023. Thieme. All rights reserved.

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