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Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization...

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Autores principales: Yeo, Leonard L. L., Jing, Mingxue, Bhogal, Pervinder, Tu, Tianming, Gopinathan, Anil, Yang, Cunli, Tan, Benjamin Y. Q., Arnberg, Fabian, Sia, Ching-Hui, Holmin, Staffan, Andersson, Tommy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459011/
https://www.ncbi.nlm.nih.gov/pubmed/34566856
http://dx.doi.org/10.3389/fneur.2021.712527
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author Yeo, Leonard L. L.
Jing, Mingxue
Bhogal, Pervinder
Tu, Tianming
Gopinathan, Anil
Yang, Cunli
Tan, Benjamin Y. Q.
Arnberg, Fabian
Sia, Ching-Hui
Holmin, Staffan
Andersson, Tommy
author_facet Yeo, Leonard L. L.
Jing, Mingxue
Bhogal, Pervinder
Tu, Tianming
Gopinathan, Anil
Yang, Cunli
Tan, Benjamin Y. Q.
Arnberg, Fabian
Sia, Ching-Hui
Holmin, Staffan
Andersson, Tommy
author_sort Yeo, Leonard L. L.
collection PubMed
description Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety.
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spelling pubmed-84590112021-09-24 Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices Yeo, Leonard L. L. Jing, Mingxue Bhogal, Pervinder Tu, Tianming Gopinathan, Anil Yang, Cunli Tan, Benjamin Y. Q. Arnberg, Fabian Sia, Ching-Hui Holmin, Staffan Andersson, Tommy Front Neurol Neurology Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety. Frontiers Media S.A. 2021-09-09 /pmc/articles/PMC8459011/ /pubmed/34566856 http://dx.doi.org/10.3389/fneur.2021.712527 Text en Copyright © 2021 Yeo, Jing, Bhogal, Tu, Gopinathan, Yang, Tan, Arnberg, Sia, Holmin and Andersson. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Yeo, Leonard L. L.
Jing, Mingxue
Bhogal, Pervinder
Tu, Tianming
Gopinathan, Anil
Yang, Cunli
Tan, Benjamin Y. Q.
Arnberg, Fabian
Sia, Ching-Hui
Holmin, Staffan
Andersson, Tommy
Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title_full Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title_fullStr Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title_full_unstemmed Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title_short Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices
title_sort evidence-based updates to thrombectomy: targets, new techniques, and devices
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459011/
https://www.ncbi.nlm.nih.gov/pubmed/34566856
http://dx.doi.org/10.3389/fneur.2021.712527
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