Stroke is a leading cause of morbidity and mortality worldwide. The increasing prevalence of acute ischemic stroke treatment has stimulated many areas of active research and contributions to literature, particularly advancements in surgical management. The aim of this chapter is to provide a comprehensive review of the indications for surgical intervention in the treatment of ischemic stroke. Specifically, the evidence surrounding the indications for mechanical thrombectomy, ventriculostomy and decompressive craniectomy is discussed. Decompressive craniectomy is further divided into individual sections on hemicraniectomy and suboccipital craniectomy. Furthermore, mechanical thrombectomy is analyzed with consideration for the plethora of recent data on perfusion imaging.
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