Endovascular treatment of cerebrovascular accident

Česká verzia

Authors: J. Kozák ^1,2; R. Kozáková ²; D. Kučera ^1,3
Authors place of work: Vaskulární centrum, Vítkovická nemocnice a. s., Ostrava ¹; Fakulta zdravotních věd, UP v Olomouci ²; II. interní klinika kardiologie a angiologie 1. LF UK a VFN v Praze ³
Published in the journal: Kardiol Rev Int Med 2016, 18(3): 151-156

Summary

Cerebrovascular accident (CVA) is one of the leading causes of patient morbidity, mortality and disability, especially in developed countries. Ischaemic CVA (iCVA) constitutes 80–85% of all CVA, the most common cause being an acute occlusion of cerebral artery, proved in more than 70% of patients within the first few hours after the onset of symptoms. An early cerebral artery recanalisation leads to reduced mortality and increased chance of patients’ self-sufficiency within 3 months after the stroke. Apart from pharmacological approaches to iCVA treatment (i.e. systemic, local, or combined administration of thrombolytics), endovascular techniques and methods are currently used. These methods have been undergoing a dynamic development during the last decade, and extensive clinical randomised trials prove their clear positive impact on the early reperfusion of the occluded cerebral artery, and, consequently, on a better prognosis for iCVA patients. The article describes individual endovascular instruments and the results of studies that demonstrated safety and efficacy of individual mechanical instruments proved by the ever-increasing proportion of successful recanalisations and relatively low risk of both periprocedural and postprocedural complications. Nowadays (since 2015) systemic thrombolysis combined with mechanical thrombectomy represents the method of choice for the treatment of major cerebral arterial occlusions within 4.5 hours after the onset of clinical symptoms, while mechanical thrombectomy alone with stent-retrievers is the standard treatment of acute symptomatic cerebral artery occlusion within 6 hours after the iCVA event.

Keywords:
ischaemic stroke – mechanical thrombectomy – stent-retrievers

Zdroje

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