Management of acute ischemic stroke: current status of pharmacological and mechanical endovascular methods

Abstract

Objective: To provide the current strategies of acute stroke management using pharmacological and interventional endovascular modalities.

Methods: Review of the literature for publications in English language literature on endovascular pharmacological and mechanical thrombolysis and clot retrieval.

Results: Aggressive management protocols have yielded therapeutic windows for effective reperfusion of ischemic brain in acute cerebral hypoperfusion/stroke. Starting with intravenous infusion of thrombolytics, which still remains to be the best feasible treatment for acute stroke management, recent advances in neuron imaging made it possible to utilize emergency cerebral angiographic evaluation of intracranial vessels followed by therapeutic measure that could be pharmacological or mechanical intervention. Intra-arterial clot lysis under image guidance combined with intravenous administration of thrombolytic is rapidly evolving with encouraging results. Microcatheters and endovascular appliances tested very positively, yielding better outcomes in acute stroke. MERCI trial, Multi MERCI trial and Stroke trials [emergency management of stroke (EMS) and interventional management of stroke (IMS)] have shown that early recanalization and reperfusion constitute good prognostic indicators by reducing mortality and improving neurological outcomes. Further trials are expected to yield better evidence to form guidelines for aggressive management of acute cerebral ischemia.

Discussion: Intravenous fibrinolysis is, to date, the best possible intervention in acute stroke and has been shown to be a better alternative to aspirin, the only known effective, pharmacological treatment. Endovascular interventions have shown very promising results with intra-arterial administration of thrombolytics as well as mechanical clot retrieving methods.

Keywords:

• STROKE
• CEREBRAL ISCHEMIA
• FIBRINOLYTICS
• ENDOVASCULAR