Semin intervent Radiol 2020; 37(02): 119-131
DOI: 10.1055/s-0040-1709153
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evolution of Stroke Thrombectomy Techniques to Optimize First-Pass Complete Reperfusion

Johanna Maria Ospel
1  Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
2  Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
,
Ryan McTaggart
3  Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Nima Kashani
2  Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
4  Department of Radiology, University of Calgary, Calgary, Canada
,
Marios Psychogios
1  Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
,
Mohammed Almekhlafi
2  Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
4  Department of Radiology, University of Calgary, Calgary, Canada
,
Mayank Goyal
2  Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
4  Department of Radiology, University of Calgary, Calgary, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
14 May 2020 (online)

Abstract

Since 2015, endovascular therapy (EVT) has become the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion. It is a safe and highly effective treatment, and its number needed to treat of 2.6 is one of the highest throughout medicine. The ultimate goal when performing EVT is to maximize chances of good outcome through achievement of fast first-pass complete reperfusion, as incomplete and delayed reperfusion increases complication rates and negatively affects outcome. Since EVT has been established as standard of care, new devices have been developed and treatment techniques have been refined. This review provides a brief overview about the rationale for and history of EVT, followed by a detailed step-by-step description of how to perform EVT using the BADDASS (BAlloon guide with large bore Distal access catheter with Dual Aspiration with Stent-retriever as Standard approach), a combined technique, which is in our opinion the safest and most effective way to achieve fast first-pass complete reperfusion. We also discuss treatment strategies for patients with simultaneous high-grade carotid stenosis/pseudoocclusion/occlusion and gaining carotid access in challenging arch anatomy, as these are commonly encountered situations in AIS, and conclude with an outlook on new technologies and future directions of EVT.