Author + information
- Received May 26, 2010
- Revision received November 9, 2010
- Accepted November 18, 2010
- Published online March 1, 2011.
- Alexander A. Khalessi, MD, MS⁎,‡,
- Sabareesh K. Natarajan, MD, MS⁎,‡,
- David Orion, MD⁎,‡,
- Mandy J. Binning, MD⁎,‡,
- Adnan Siddiqui, MD, PhD⁎,†,‡,
- Elad I. Levy, MD⁎,†,‡ and
- L. Nelson Hopkins, MD⁎,†,‡,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. L. Nelson Hopkins, University at Buffalo Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, 3 Gates Circle, Buffalo, New York 14209
This review summarizes the current state-of-the-art regarding the endovascular management of acute ischemic stroke. Beginning with intravenous tissue plasminogen activator, this paper traces the gradual shift of systemic thrombolysis from a competing to complementary treatment modality. Intra-arterial thrombolysis, mechanical thrombectomy with the Merci (Concentric Medical, Mountain View, California) and Penumbra (Penumbra, Inc., Alameda, California) systems, angioplasty, primary intracranial stenting, and emerging stentriever devices are sequentially reviewed. Ultimately, this paper lays the foundation for current endovascular stroke management and considers future areas of progress and research.
- acute ischemic stroke
- endovascular therapy
- mechanical thrombectomy
- stent-assisted revascularization
Dr. Khalessi is the recipient of the 2010–2011 Congress of Neurological Surgeons/MicroVention Vascular Fellowship. Dr. Natarajan is the recipient of the 2010–2011 Cushing Award of the Congress of Neurological Surgeons. Drs. Orion and Binning have reported that they have no relationships to disclose. Dr. Siddiqui has received research grants from the National Institutes of Health (co-investigator: NINDS 1R01NS064592-01A1, Hemodynamic Induction of Pathologic Remodeling Leading to Intracranial Aneurysms) and the University at Buffalo (Research Development Award); holds financial interests in Hotspur, Intratech Medical, StimSox, and Valor Medical; serves as a consultant to Codman & Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, and Penumbra; serves on the Speakers' Bureaus of Codman & Shurtleff, Inc. and Genentech; serves on an advisory board for Codman & Shurtleff; and has received honoraria from Abbott Vascular, American Association of Neurological Surgeons courses, an Emergency Medicine Conference, Genentech, Neocure Group LLC, and from Abbott Vascular and Codman & Shurtleff, Inc. for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. Dr. Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr. Levy receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices), honoraria from Boston Scientific, and research support from Codman & Shurtleff, Inc. and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd. and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman & Shurtleff, Inc., as a consultant per project and/or per hour for Codman & Shurtleff, Inc., ev3/Covidien Vascular Therapies, and TheraSyn Sensors, Inc.; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. Dr. Levy receives no consulting salary arrangements; all consulting is per project and/or per hour. Dr. Hopkins receives research study grants from Abbott (ACT 1 Choice), Boston Scientific (CABANA), Cordis (SAPPHIRE WW), and ev3/Covidien Vascular Therapies (CREATE) and a research grant from Toshiba (for the Toshiba Stroke Research Center); has an ownership/financial interest in AccessClosure, Boston Scientific, Cordis, Micrus, and Valor Medical; serves on the Abbott Vascular Speakers' Bureau; receives honoraria from Bard, Boston Scientific, Cordis, and for speaking at Complete Conference Management, Cleveland Clinic, and the Society for Cardiovascular Angiography and Interventions (SCAI) conferences; receives royalties from Cordis (for the AngioGuard device); serves as a consultant to or on the advisory board for Abbott, AccessClosure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical, and Toshiba; and serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC.
- Received May 26, 2010.
- Revision received November 9, 2010.
- Accepted November 18, 2010.
- American College of Cardiology Foundation
- Stroke Epidemiology
- Patient Selection
- IV Thrombolysis
- Intra-Arterial (IA) Thrombolysis
- Combined IV and IA Thrombolysis
- Mechanical Thrombectomy
- Stent-Assisted Revascularization for Acute Ischemic Stroke
- Stent-Assisted Revascularization: Durability, Late Outcomes, and the Rise of Stentrievers