Endovascular therapy

A new adjunct therapy for acute ischaemic stroke is mechanical thrombectomy. A variety of proprietary devices exist to disrupt, retrieve or aspirate clots using intra-arterial endovascular techniques.

A number of systematic reviews or meta-analyses suggest that these approaches offer additional benefit as an adjunct to thrombolysis in certain patient populations only [36, 37].

The UK Royal College of Physicians recommend this approach for [1]:

• Patients with a proximal intracranial large vessel occlusion causing a disabling neurological deficit (NIHSS score of 6 or more) if the procedure can begin (arterial puncture) within 5 hours of known onset.
• If the large artery occlusion is in the posterior circulation, treatment up to 24 hours after onset may be appropriate

These proximal large vessel occlusions include the intracranial or extracranial ICA, M1 or M2 middle cerebral artery or basilar artery.

Access to this service is challenging, requiring appropriately trained specialists with regular experience in intracranial endovascular interventions, with appropriate facilities and neuroscience support [38].

424 patients received this treatment in 2015/16 across England, Wales and Northern Ireland [21].