Endovascular treatment of acute ischemic stroke: Imaging-based patient selection and results in clinical practice

The introduction of endovascular treatment (EVT) for acute ischemic stroke due to large vessel occlusion has resulted in an increase in patients regaining functional independence to around 40%. However, the other 60% still does not reach a favorable outcome, regardless of reperfusion being achieved in half of these patients. Identifying parameters pertaining to patients without expected benefit from EVT would allow for patient selection, with the aim of reducing the proportion of patients with futile reperfusion. The first aim of this thesis was to investigate the suitability of collaterals, early ischemic changes and venous drainage as patient selection criteria for EVT (Part I). The second aim of this thesis was to determine outcomes and safety of EVT in clinical practice (Part II). Part I indicates that collaterals, early ischemic changes, and venous drainage modify the benefit of EVT on either functional outcome or follow-up infarct volume. However, with these parameters, we were not able to reliably identify a patient group without this benefit. As such, we have not provided proof that, applying current grading methods, excluding patients for EVT solely based on assessment of either collaterals, ischemic changes or venous drainage within the 6-hour time window is justified. Part II concludes that in clinical practice, EVT for patients with acute ischemic stroke due to large vessel occlusion is at least as effective and safe as in the setting of a randomized controlled trial.