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Matthew R B Evans1, Phil White2, Peter Cowley1,3, David J Werring1Stroke Research Centre, Department of Brain repair and Rehabilitation, University College London Institute of Neurology, London, UKStroke Research Centre, Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle Upon Tyne, UKNeuroradiological Academic Unit, University College London Institute of Neurology https://teebeeth37120.blogspot.com/2022/04/the-paris-listed-high-end-items.html , London, UKAbstractRapid, safe and effective arterial recanalisation to restore blood flow and improve functional outcome remains the primary goal of hyperacute ischaemic stroke management. The benefit of intravenous thrombolysis with recombinant tissue type plasminogen activator for patients with severe stroke due to large artery occlusion is limited; early recanalisation is generally less than 30% for carotid, proximal middle cerebral artery or basilar artery occlusion. Since November 2014, nine positive randomised controlled trials of mechanical thrombectomy for large vessel occlusion in the anterior circulation have led to a revolution in the care of patients with acute ischaemic stroke. Its efficacy is unmatched by any previous therapy in stroke medicine, with a number needed to treat of less than 3 for improved functional outcome. With effectiveness shown beyond any reasonable doubt, the key challenge now is how to implement accessible, safe and effective mechanical thrombectomy services. This review aims to provide neurologists and other stroke physicians with a summary of the evidence base, a discussion of practical aspects of delivering the treatment and future challenges. About 80% of acute strokes are ischaemic,9 mainly from large vessel occlusion due to either artery to artery embolism or cardiac embolism. Early treatment is critical to rescue potentially salvageable tissue ('time is brain')10 11: safe, rapid and effective arterial recanalisation to restore blood flow and improve functional outcome remains the primary goal of hyperacute ischaemic stroke management.1Until recently, the only licensed treatment for acute ischaemic stroke was intravenous thrombolysis with recombinant tissue type plasminogen activator (IV r tPA). However, since November 2014, nine positive randomised controlled trials of mechanical thrombectomy have been published (table 1), leading to a revolution in the care of patients with acute ischaemic stroke due to large vessel occlusion in the anterior circulation. The efficacy of this treatment is unmatched by any previous therapy in stroke medicine, with a number needed to treat of less than 3for improved functional outcome.13 With effectiveness shown beyond any reasonable doubt, the key challenge is how to implement safe and effective services accessible to the patients who need it.
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