Beyond tissue plasminogen activator: Mechanical intervention in acute stroke

Megan C. Leary, Jeffrey L. Saver, Y. Pierre Gobin, Reza Jahan, Gary R. Duckwiler, Fernando Vinuela, Chelsea S. Kidwell, John Frazee, Sidney Starkman

Research output: Contribution to journalReview article

52 Scopus citations


Mechanical interventions in acute ischemic stroke promise to provide emergency physicians with tools to treat patients in whom conventional thrombolysis might be ineffective or contraindicated, including most patients with stroke who arrive at the emergency department beyond the 3-hour time window for intravenous tissue plasminogen activator. A systematic MEDLINE literature review was performed. Endovascular interventions currently in early human clinical trials include the use of lasers, ultrasonography, angioplasty, microsnares, and a variety of clot-retrieval devices. Potential advantages of these approaches include more rapid recanalization of occluded vessels, reduced or no exposure to fibrinolytic agents, and a longer treatment window. Early safety trials are promising, with serial improvements in device design to minimize trauma to cerebrovascular endothelium and accelerate vessel recanalization. The purpose of this review is to provide the emergency medicine community with an understanding of these promising and emerging approaches to acute stroke therapy.

Original languageEnglish (US)
Pages (from-to)838-846
Number of pages9
JournalAnnals of emergency medicine
Issue number6
StatePublished - Jun 1 2003
Externally publishedYes


ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Leary, M. C., Saver, J. L., Gobin, Y. P., Jahan, R., Duckwiler, G. R., Vinuela, F., Kidwell, C. S., Frazee, J., & Starkman, S. (2003). Beyond tissue plasminogen activator: Mechanical intervention in acute stroke. Annals of emergency medicine, 41(6), 838-846.