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.
Keywords
aspiration - balloon guide catheter - mechanical thrombectomy - endovascular therapy
- ischemic stroke - reperfusion - interventional radiology
