J Cerebrovasc Endovasc Neurosurg.  2018 Mar;20(1):53-60. 10.7461/jcen.2018.20.1.53.

The Evolution of the Neurosurgical Treatment of Ischemic Stroke

• Withrow J
• Todnem N
• Rahimi S

• KMID: 2422561
• DOI: http://doi.org/10.7461/jcen.2018.20.1.53

Abstract

The neurosurgical approach to the management of ischemic stroke has evolved dramatically over the past century with the bulk of these changes occurring over the past 25 years. With recent advances in technology and continued refinements in neurosurgical techniques there has been significant improvement to the safety and efficacy of our treatment options. The focus of this article will be to review the historical and recent reports in the literature related to revascularization techniques.

Keyword

Brain ischemia/drug therapy; Fibrinolytic agents; Stroke/diagnosis; Thrombolytic therapy; Tissue plasminogen activator/therapeutic use; Infusions; intra-arterial; Stents

MeSH Terms

Fibrinolytic Agents
Stents
Stroke*
Thrombolytic Therapy
Fibrinolytic Agents

Figure

• 

  Fig. 1 (A) shows the initial deployment of the Penumbra device proximal to the clot. (B, C) show the separator disrupting the clot and suctioning of the fragments through the microcatheter.

• 

  Fig. 2 (A, B) show the deployment of a stent retriever. The device and microcatheter are inserted distal to the clot and the microcatheter is withdrawn proximally leaving the stent retriever embedded throughout the clot. (C) shows the stent retriever being withdrawn into the microcatheter carrying the clot after the 3-5 minute waiting period for the clot retriever to stabilize within the clot.

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