Endovascular therapy and imaging

The earliest reports of endovascular therapy for acute stroke date to the early 1980s and predate US Food and Drug Administration approval of IV tissue plasminogen activator (tPA). Initial approaches included regional infusion of urokinase in the extracranial carotid,1,–,3 followed later by reports of direct infusions into intracranial arteries through a catheter embedded in a thrombus.4 Since then, development of new devices and greater availability of interventional operators have resulted in steady growth of endovascular treatment for stroke. Despite impressive rates of recanalization, approaching 90%, good clinical outcomes occur for fewer than 50% of treated patients.5,6 It is likely that multiple factors contribute to the discrepancy between recanalization and good outcomes. Recanalization of the arterial occlusion does not always result in adequate restoration of perfusion to the ischemic area. Reocclusion may occur after the angiographic procedure is completed.7 The interval from stroke onset to reestablishing adequate flow is an important variable, and evidence suggests that the more rapidly the artery is opened …