NEW STRATEGIES FOR ACUTE STROKE INTERVENTION


Horst Sievert, M.D., CardioVascular Center Frankfurt, Frankfurt, Germany

Stroke is the third leading cause of death and leading cause of disability in western countries. Though progress has been made in acute stroke intervention with the use of intravenous thrombolytic therapy, a large number of patients remain significantly disabled despite thrombolysis. Importantly, the most disabling strokes, those related to the M1 segment occlusion of the middle cerebral artery, to thrombus or embolus lodged at the internal carotid bifurcation and basilar artery occlusions do not respond well to intravenous thrombolytic therapy. Moreover, intravenous thrombolysis can only be used in a short time interval and provided there are no contraindications. Hence, only a small number of patients are eligible for intravenous thrombolytic therapy. Therefore, alternative treatment strategies are needed. Attention has been directed in the last two decades to intra-arterial thrombolysis and percutaneous removal of thromboembolic material. In this context, several concepts have been studied including intracranial balloon angioplasty and stenting with variable results. Most recently, a concept has been explored with promising results, removal of thromboembolic material with stentrievers, self-expanding stents that are deployed at the site of thromboembolic material. The thrombus/embolus is captured within the stent and the stent removed together with the captured material into a balloon-tipped guide catheter while the balloon remains inflated minimizing the risk of embolization during stent removal. The presentation is an overview of interventional concepts of acute stroke therapy including a review of recent data using the concept of stentrievers.