Endovascular Techniques for Emergent Large Vessel Occlusion

Abstract

Care for acute ischemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Stroke care was revolutionized in 2015 with the publication of the first randomized controlled trials (RCTs) showing that endovascular treatment is more effective than intravenous thrombolysis alone for patients with large vessel occlusion (LVO) stroke and later trials showing benefit up to 24 h in select patients. While endovascular therapy is highly effective, several devices and techniques exist, and each possesses unique benefits and risks. In recent years, techniques have become more standardized with the uses of thrombus aspiration, stent retrievers, and/or combinations thereof, and revascularization and patient outcomes have accordingly shown improvement in a meaningful manner. This review chapter will present a brief overview of LVO management, selection criteria with focus on symptomatology and imaging, and techniques and devices used.