Stroke is the second leading cause of mortality and the third leading cause of disability-adjusted life-years worldwide. For each minute of an ischemic stroke, an estimated 1.9 million brain cells die. The year 2015 saw the unprecedented publication of 5 multicentre, randomized, controlled trials. These studies showed that patients with acute ischemic stroke caused by large-vessel thrombus occlusion of the proximal anterior circulation had significantly reduced disability at 90 days when treated with endovascular thrombectomy and usual stroke care compared to usual stroke care alone. As a result, endovascular thrombectomy is now the new North American and European standard of care for suitable patients with acute ischemic stroke caused by large-vessel proximal anterior circulation occlusion. We review key take-home messages in this paradigm shift for radiologists, including the importance of time and workflow efficiency, what currently constitutes appropriate preimaging patient selection and imaging criteria, the use of newer generation thrombectomy devices, safety outcomes, as well as further areas still in need of elucidation.
HankeyG.J.The global and regional burden of strokeLancet Glob Health2013; 1:e239–e240.
2.
BerkhemerO.A.FransenP.S.S.BeumerD.for the MR CLEAN Trial InvestigatorsA randomized trial of intraarterial treatment for acute ischemic strokeN Engl J Med2015; 372:11–20.
3.
CampbellB.C.V.MitchellP.J.KleinigT.J.for the EXTEND IA Trial InvestigatorsEndovascular therapy for ischemic stroke with perfusion-imaging selectionN Engl J Med2015; 372:1009–1018.
4.
GoyalM.DemchukA.M.MenonB.K.for the ESCAPE Trial InvestigatorsRandomized assessment of rapid endovascular treatment of ischemic strokeN Engl J Med2015; 372:1019–1030.
5.
SaverJ.L.GoyalM.BonafeA.for the SWIFT PRIME Trial InvestigatorsStent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in strokeN Engl J Med2015; 372:2285–2295.
6.
JovinT.G.ChamorroA.CoboE.for the REVASCAT Trial InvestigatorsThrombectomy within 8 hours after symptom onset in ischemic strokeN Engl J Med2015; 372:2296–2306.
7.
van SwietenJ.C.KoudstaalP.J.VisserM.C.SchoutenH.J.A.van GijnJ.Interobserver agreement for the assessment of handicap in stroke patientsStroke1988; 19:604–607.
8.
CicconeA.ValvassoriL.NichelattiM.for the SYNTHESIS Expansion InvestigatorsEndovascular treatment for acute ischemic strokeN Engl J Med2013; 368:904–913.
9.
KidwellC.S.JahanR.GornbeinJ.for the MR RESCUE InvestigatorsA trial of imaging selection and endovascular treatment for ischemic strokeN Engl J Med2013; 368:914–923.
10.
BroderickJ.P.PaleschY.Y.DemchukA.M.for the IMS III InvestigatorsEndovascular therapy after intravenous t-PA versus t-PA alone for strokeN Engl J Med2013; 368:893–903.
11.
GoyalM.MenonB.K.van ZwamW.H.for the HERMES collaboratorsEndovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trialsLancet2016; 387:1723–1731.
12.
CasaubonL.K.BoulangerJ.M.BlacquiereD.Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015Int J Stroke2015; 10:924–940.
13.
PowersW.J.DerdeynC.P.BillerJ.2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for health care professionals from the American Heart Association/American Stroke AssociationStroke2015; 46:3020–3035.
14.
WahlgrenN.MoreiraT.MichelP.Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska stroke update 2014/2015, supported by ESO, ESMINT, ESNR and EANInt J Stroke2016; 11:134–147.
15.
SaverJ.L.Time is brain—quantifiedStroke2006; 37:263–266.
16.
StrathearnL.SimpkinW.PhillipsS.J.ShankarJ.J.S.Institution of dedicated acute stroke protocol helped in achieving target door-to-CT time and thereby faster delivery of thrombolytic therapy May 18–23, 2013Scientific poster (print). ASNRSan Diego, USA
17.
BhatiaR.HillM.D.ShobhaN.Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in acute ischemic stroke: real-world experience and a call for actionStroke2010; 41:2254–2258.
18.
PexmanJ.H.W.BarberP.A.HillM.D.Use of the Alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute strokeAJNR Am J Neuroradiol2001; 22:1534–1542.
19.
University of Calgary Faculty of Medicine. Alberta Health Services. Understanding Albert Stroke Program Early CT Score (ASPECTS). Available at: http://www.aspectsinstroke.com. Accessed July 15, 2016.
20.
AlbersG.W.GoyalM.JahanR.Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIMEAnn Neurol2016; 79:76–89.
21.
BorstJ.BerkhemerO.A.RoosY.B.W.E.M.van BavelE.van ZwamW.H.van OostenbruggeR.J.Value of computed tomographic perfusion-based patient selection for intra-arterial acute ischemic stroke treatmentStroke2015; 46:3375–3382.
22.
ShankarJ.J.S.LanglandsG.DoucetteS.PhillipsS.J.Does CT perfusion imaging in acute ischemic stroke predict final infarct volume: inter-observer studyCan J Neurol Sci2016; 43:93–97.
23.
GoyalM.MenonB.K.DerdeynC.P.Perfusion imaging in acute ischemic stroke: let us improve the science before changing clinical practiceRadiology2013; 266:16–21.
24.
SchaeferP.W.SouzaL.KamalianS.Limited reliability of computed tomographic perfusion acute infarct volume measurements compared with diffusion-weighted imaging in anterior circulation strokeStroke2015; 46:419–424.
25.
NaelK.KhanR.ChoudharyG.Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundariesStroke2014; 45:1985–1991.
26.
ShethK.N.TerryJ.B.NogueiraR.G.Advanced modality imaging evaluation in acute ischemic stroke may lead to delayed endovascular reperfusion therapy without improvement in clinical outcomesJ Neurointerv Surg5suppl 12013i62–i65.
