Improving the Effectiveness of Endovascular Treatment in Acute Ischemic Stroke: Optimized Patient Selection, Reperfusion Strategy, and Post-thrombectomy Management.
Year: 2026
Type: article
Abstract: Background. Endovascular thrombectomy has fundamentally changed the treatment of acute ischemic stroke caused by large-vessel occlusion. Despite technically successful reperfusion in a substantial proportion of treated patients, functional independence is not achieved in many cases. The discrepancy between angiographic success and clinical recovery emphasizes the importance of optimizing the entire treatment pathway rather than focusing exclusively on clot retrieval.Objective. To analyze contemporary approaches for improving the effectiveness of endovascular treatment in acute ischemic stroke, with particular attention to patient selection, imaging strategy, treatment time, bridging intravenous thrombolysis, first-pass reperfusion, large-core infarction, posterior circulation stroke, and post-thrombectomy management.Materials and Methods. A targeted clinical review of landmark randomized controlled trials, meta-analyses, and current international recommendations concerning endovascular treatment of acute ischemic stroke was performed. Published clinical data were analyzed with emphasis on 90-day modified Rankin Scale outcomes, reperfusion success, symptomatic intracranial hemorrhage, mortality, and procedural factors associated with favorable neurological recovery.Results. Modern evidence demonstrates that the benefit of thrombectomy extends beyond patients with small infarct cores and conventional early treatment windows. Selected patients with large ischemic cores and patients with basilar artery occlusion can obtain clinically meaningful benefit from endovascular treatment. Treatment delay remains a major determinant of outcome. Effective stroke systems therefore require rapid vascular imaging, parallel preparation for thrombolysis and thrombectomy, minimization of door-to-puncture and puncture-to-reperfusion intervals, and maximization of first-pass complete or near-complete reperfusion. Recent evidence also supports careful post-procedural hemodynamic management and avoidance of excessively intensive blood-pressure reduction after successful reperfusion.Conclusion. Improving endovascular treatment effectiveness requires integration of rapid diagnosis, expanded but evidence-based patient selection, efficient reperfusion techniques, appropriate intravenous thrombolysis, standardized peri-procedural management, and structured post-thrombectomy care. Implementation of a unified neurovascular pathway may improve clinical outcomes in tertiary neurosurgical centers.
Source: MEDICAL RESEARCH JOURNAL
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220263444