Der Radiologe
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Acute extracranial internal carotid artery (ICA) occlusions resulting in ischemic stroke are different from other forms of acute occlusions of cerebral vessels. The pathophysiological process involved in occlusion of the extracranial ICA is similar to processes observed in acute occlusion of the coronary arteries. ⋯ In these patients primary stenting of acute extracranial occlusions of the ICA is a treatment option with good clinical results. This review discusses the endovascular treatment of acute extracranial ICA occlusions.
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The management of acute stroke patients suffers from several major problems in the daily clinical routine. In order to achieve optimal treatment a complex diagnostic work-up and rapid initiation of therapy are necessary; however, most patients arrive at hospital too late for any type of acute stroke treatment, although all forms of treatment are highly time-dependent according to the generally accepted "time is brain" concept. ⋯ Currently, mobile stroke units are in operation in various countries and should lead to an improvement in stroke treatment; nevertheless, intensive research is still needed to analyze the best framework settings for prehospital stroke management.
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Due to the positive evidence for mechanical thrombectomy (mTE), it will be increasingly used in future. Profound knowledge of potential complications, prevention and management of complications is necessary to safely implement mTE into clinical practice. ⋯ Clinically relevant complications of mTE are rare. Preventive measures and effective management of complications may even increase safety. Stenoses occasionally occur as a long-term side effect but are asymptomatic in the majority of cases.