Purpose of review: This review discusses the present use of interventional transcatheter strategies to treat patients with acute brain ischemia and severe stenosis of intracranial large arteries.
Recent findings: The benefits and risks of opening freshly occluded intracranial large arteries in patients with brain ischemia depend on the extent of infarction, the location, the mechanism of thromboembolism, and the clot burden present, as well as time. Mechanical removal of thromboemboli with stent retrievers can quickly and effectively open occluded arteries. Aggressive medical treatment is highly effective in stabilizing intracranial large artery atherostenotic lesions.
Summary: Interventional treatment of acute and threatened brain ischemia is a rapidly changing field. New devices, new thrombolytic agents, and new antithrombotic agents are continuously being introduced and tested. Diagnostic imaging advances are improving the ability of clinicians to identify the important features needed to select patients optimally. Interventionalists are gaining experience with their new tools. Key questions remain including patient selection criteria, use of optimal brain and vascular imaging, appropriate devices for recanalization, and the concomitant use of intravenous thrombolytics, among others.