Endovascular Treatment of Acute Stroke

This chapter explores the critical role of endovascular treatment (EVT) in the management of acute ischemic stroke caused by large vessel occlusions (LVOs). It provides a comprehensive overview of the pathophysiology of ischemic stroke, emphasizing the time-sensitive nature of restoring cerebral blood flow to salvage brain tissue. Key procedural techniques such as mechanical thrombectomy using stent retrievers and aspiration catheters are discussed, alongside their combinations. Guidelines for patient selection are explained in the light of the results of pivotal clinical trials—MR CLEAN, SWIFT-PRIME, ESCAPE, EXTEND-IA, REVASCAT, DAWN, DEFUSE-3—that established EVT as the gold standard for stroke patients presenting within 6 hours (golden hours) and extended window till 24 hours of symptom onset. Patient selection criteria based on advanced imaging (CT perfusion and MR angiography) are detailed, highlighting the importance of identifying the ischemic penumbra. Technical challenges, complication management along with special situations like posterior circulation stroke and medium vessel occlusions are also covered in this chapter.