Abstract
Acute ischemic stroke therapy has rapidly evolved over the past two decades. Recently,
a paradigm shift has occurred in the treatment of acute ischemic stroke due to large
vessel occlusion with the publication of several randomized trials proving that mechanical
thrombectomy with stent retriever devices improves clinical outcome in comparison
to intravenous thrombolysis. Furthermore, pooled data from the clinical trials suggest
that mechanical thrombectomy can improve outcome in a broad range of patients, and
that the sooner the intervention can be performed, the greater the benefit. Delays
in endovascular stroke therapy can occur during multiple time points during a patient's
encounter, and these time delays are associated with worse outcomes. This association
emphasizes the importance of enhancing speed-of-care processes in patients undergoing
endovascular reperfusion. Efforts to reduce time delays in endovascular stroke treatment
can be achieved by reflecting on the health care initiatives that took place for the
treatment of acute myocardial infarction almost 20 years ago. The ideal system of
care to reduce delays in endovascular stroke therapy will likely include rapid transport
of all eligible patients directly to the angiography suite to bypass the inefficiencies
of workflow during the early inhospital setting. These strategies will undoubtedly
take time to implement, as they require further research, infrastructure funding,
and policy changes at local, regional, and national levels.
Keywords
endovascular therapy - acute ischemic stroke - mechanical thrombectomy/embolectomy
- stent retriever
