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Review
Acute ischaemic stroke interventions: large vessel occlusion and beyond
  1. Ahmad Sweid1,
  2. Batoul Hammoud2,
  3. Sunidhi Ramesh3,
  4. Daniella Wong3,
  5. Tyler D Alexander3,
  6. Joshua Harrison Weinberg1,
  7. Maureen Deprince1,
  8. Jaime Dougherty1,
  9. Dimitri Jean-Mickael Maamari4,
  10. Stavropoula Tjoumakaris1,
  11. Hekmat Zarzour1,
  12. Michael R Gooch1,
  13. Nabeel Herial1,
  14. Victor Romo5,
  15. David M Hasan6,
  16. Robert H Rosenwasser1,
  17. Pascal Jabbour1
  1. 1 Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  2. 2 Endocrinology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3 Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  4. 4 School of Medicine, American University of Beirut, Beirut, Lebanon
  5. 5 Anesthesia, Thomas Jefferson University—Center City Campus, Philadelphia, Pennsylvania, USA
  6. 6 Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Pascal Jabbour; Pascal.jabbour{at}jefferson.edu

Abstract

Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for patients, families and society in the pre-intervention era. A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke; this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming benefits. This review article will present a comprehensive overview of LVO management, techniques and devices used, and the future of stroke therapy. In addition, we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.

  • large vessel occlusion
  • mechanical thrombectomy
  • functional outcome
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2019-000262

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    Footnotes

    • Twitter @PascalJabbourMD

    • Contributors All authors reviewed and agreed on the final version of the manuscript. Conception or design of the work: AS, BH, SR, JHW, PJ. Drafting the work: AS, BH, SR, DW, TDA, MD, JD, DJ-MM. Revising the work for valuable intellectual content: MRG, HZ, VR, DMH, RHR. Final approval of the version: ST, PJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PJ is a consultant for Medtronic and Micro Vention. ST is a consultant for Stryker.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.