Endovascular Therapy Techniques for Acute Ischemic Stroke

Acute ischaemic stroke due to large vessel occlusion represents a leading cause of disability and mortality globally. Endovascular therapy for such strokes comprises minimally invasive techniques—mechanical thrombectomy with stent retrievers, direct aspiration catheters and combined approaches—to achieve rapid recanalisation of occluded cerebral arteries. Patient selection relies on advanced imaging protocols, including non-contrast CT, CT angiography and perfusion imaging, to delineate infarct core and penumbral tissue. Landmark randomised studies have established the superiority of endovascular intervention over intravenous thrombolysis alone within established time windows, leading to widespread adoption of comprehensive stroke centre models. Recent innovations in device design, vascular access techniques and intra-arterial thrombolytic delivery aim to enhance first-pass success and reduce procedural complications. Integrating perfusion imaging and flat-detector CT in the angiography suite has streamlined workflow by obviating patient transfers, while refined protocols for conscious sedation versus general anaesthesia and multidisciplinary standard operating procedures have minimised door-to-puncture times. Together, these advances have transformed acute stroke care pathways and improved functional outcomes worldwide.

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Endovascular Therapy Techniques for Acute Ischemic Stroke publication trend

The graph below shows the total number of articles in endovascular therapy techniques for acute ischemic stroke across all publications each year (not limited to Nature Index journals).

Technical terms

Mechanical thrombectomy: A procedure that removes a thrombus using specialised devices (e.g. stent retrievers or aspiration catheters) to reopen occluded cerebral arteries.

Perfusion imaging: A radiological technique (CT or MRI based) that assesses blood flow parameters (cerebral blood flow, volume and mean transit time) to distinguish salvageable brain tissue from infarct core.

Large vessel occlusion (LVO): Blockage of a major intracranial artery supplying a large territory, responsible for severe stroke syndromes often amenable to endovascular intervention.

Penumbra: The region of brain tissue surrounding an infarct core that is hypoperfused but potentially salvageable if reperfusion is achieved promptly.

Flat-detector CT: An imaging modality integrated into angiography suites that provides rapid vascular and perfusion data without the need to transfer the patient to a separate CT scanner.

References

1. Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial. The Lancet Neurology (2024).
2. Dynamic Angiography and Perfusion Imaging Using Flat Detector CT in the Angiography Suite: A Pilot Study in Patients with Acute Middle Cerebral Artery Occlusions. American Journal of Neuroradiology (2015).
3. Effects of Workflow Optimization in Endovascularly Treated Stroke Patients – A Pre-Post Effectiveness Study. PLOS ONE (2016).
4. One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times. American Journal of Neuroradiology (2019).
5. Effect of Pre- and In-Hospital Delay on Reperfusion in Acute Ischemic Stroke Mechanical Thrombectomy. Stroke (2020).