Endovascular Interventions for Acute Ischemic Stroke

Objective: To review recent endovascular intervention trials for acute ischemic stroke. Data Sources: Recent, randomized controlled trials of endovascular interventions for acute ischemic stroke were identified. The search terms “endovascular” AND “stroke” were used and filter for “randomized controlled trial” was applied; the period searched was January 1, 2013, to October 31, 2015. Study Selection and Data Extraction: Randomized controlled trials of endovascular interventions in acute ischemic stroke published within the past 3 years (2013-2015). Data Synthesis: A total of 8 trials are reviewed: 3 trials published in 2013 demonstrated neutral results for endovascular interventions, and 5 trials published in 2015 demonstrated positive results for endovascular interventions. Potential reasons for the change in outcomes include better patient selection and improvement indevice technology. Patient selection improvements included selecting patients with salvageable brain tissue with an identifiable thrombus on perfusion imaging. The major improvement in device technology was the introduction of the Solitaire Flow Restoration stent retriever and the Trevo stent retriever, both of which have improved recanalization rates compared with earlier devices. Adjunctive medication considerations include the mode of sedation (general or conscious), intraprocedural anticoagulation with heparin, and intra-arterial tissue plasminogen activator. Conclusions: The use of endovascular devices for treating acute ischemic stroke is likely to increase as more centers become capable of integrating them into their stroke programs. It is important for pharmacists to understand the trials that evaluated endovascular interventions because differences exist with respect to device, adjunctive medication, and patient selection, all of which affect patient outcomes.