Rescue Treatment Option for Intracranial Artery Occlusion

초록

In the patient with hyper-acute ischemic stroke, intracranial large artery oc¬clusion after intravenous thrombolysis is usually considered as the candidate for endovascular therapy. Particularly mechanical thrombectomy by stent retrieval is an effective and relatively safe treatment option for adjunct to intravenous rTPA infusion. sometimes, stent retrieval and Penumbra suction resulted in failure of recanalization. In this brief review, we analyzed seven randomized clinical trials supporting the efficacy of stent retrieval about failure of recanalization. These studies showed six to forty percentage of recanalization failure rate in spite of mechanical thrombectomy. Conventional angiography, MR perfusion and diffusion weighted images can be helpful for the decision of rescue therapy. The treatment option for rescue therapy is wire manipulation, intra-arterial thrombolytics infusion, and balloon angioplasty in addition to stent insertion and bypass surgery. We evaluate the current literature regarding treatment of intracranial atherosclerotic disease, with particular emphasis on these rescue endovascular trials and described the characteristics of intracranial stenting and bypass surgery and related complication.