Acute Stroke Treatment: Thrombectomy

A large vessel occlusion (LVO) occurs in about one-third of all ischemic strokes and is an indication for an intervention called endovascular thrombectomy. Data have demonstrated that thrombectomy, with or without thrombolytic therapy, could offer significant functional recovery, even up to 24 h from symptom onset. Specific exam findings, including gaze deviation, aphasia, and neglect, should raise concern for LVO. CT angiogram (CTA) is very sensitive for identifying an LVO. Reviewing the scan with a neuroradiologist, neurologist, and interventionalist can be very helpful and educational. Suitable patients for thrombectomy should be reasonably independent and have a low risk of complications such as intracranial hemorrhage or procedural stroke. Following thrombectomy, patients need frequent neurological monitoring in an ICU setting to detect and manage these complications.