Treatment of Stroke Patient in the Acute Setting

The clinical progression of acute ischemic stroke (AIS) is strongly correlated with early recanalization. Patients with occlusion of large arteries, those with scores of high clinical severity (NIHSS score > 12) are unlikely to benefit from thrombolytic therapy (rt-PA) and those for which the fibrinolytic treatment failed are potential candidates for mechanical revascularization techniques. Mechanical systems used for revascularizationeither act as thrombo-aspiration or mechanical removal of by clots by non-implantable stents. Multiple single-center retrospective studies have shown the value of these techniques. Prospective trials and one randomized controlled trial evaluating the contribution of thrombectomy in case of failure of intravenous thrombolysis (THRACE study) are underway. Thrombectomy has acceptable results in terms of efficacy and safety in the treatment of patients with AIS and is an attractive therapeutic option for patients out of time or contraindicated to fibrinolytic therapy. Inclusion of invasive techniques in the armamentarium of cerebral infarction in combination with rt-PA or as first-line treatment on one hand and the method of selecting patients by MRI or CT Perfusion on the other hand are challenges that must be addressed to validate the mechanical thrombectomy therapeutic option in the future.