A case-based guide to the interventional management of stroke from leading international experts! Stroke is the most prevalent cerebrovascular emergency, impacting an estimated 15 million people worldwide every year. Endovascular treatment (EVT) of ischemic stroke has expanded at an unforeseen pace, with EVT the most common neurointerventional procedure performed at most large centers. Endovascular Management of Ischemic Stroke: A Case-Based Approach by renowned stroke pioneer Vitor Mendes Pereira and distinguished co-editors features contributions from a "who's who" of global experts. This practical resource provides straightforward guidance for clinicians who need to learn and master state-of-the-art endovascular interventions reflecting the new, evidenced-based treatment paradigm for acute stroke. This carefully crafted reference takes readers on a journey from the early building blocks that led to modern stroke interventions to meticulous step-by-step descriptions of the latest approaches. Fifty high-yield cases mirror real-life scenarios trainees and professionals are likely to encounter in clinical practice. Seven sections encompass a full spectrum of diverse patient presentations, anatomical variations, advanced techniques, complex pathologies, complications, and stroke mimics. Key Highlights Discussion of emerging techniques likely to stand the test of time such as SAVE, ARTS, transradial access, and transcarotid access Stroke mimics important for differential diagnoses, including hemiplegic migraine, MELAS, RCVS, seizure, and more An appendix that covers fundamental terms, trials, and tools This cutting-edge resource is essential reading for trainee and early-career interventionalists, as well as seasoned practitioners in interventional radiology, neuroradiology, endovascular neurosurgery, and interventional neurology.

"Stroke is the most prevalent cerebrovascular emergency, impacting an estimated 15 million people worldwide every year. Endovascular treatment (EVT) of ischemic stroke has expanded at an unforeseen pace, with EVT the most common neurointerventional procedure performed at most large centers. Endovascular Management of Ischemic Stroke: A Case-Based Approach by renowned stroke pioneer Vitor Mendes Pereira and distinguished co-editors features contributions from a "who's who" of global experts. This practical resource provides straightforward guidance for clinicians who need to learn and master state-of-the-art endovascular interventions reflecting the new, evidence-based treatment paradigm for acute stroke"--

Background: Direct oral anticoagulants (DOACs) are increasingly being prescribed. Compliant patients are excluded from iv-tPA and solely rely on mechanical thrombectomy for revascularization. DOAC-use may be related to development of small emboli causing distal occlusions potentially inaccessible for mechanical thrombectomy. We aimed to assess patientsu2019 eligibility for mechanical thrombectomy and risk of post-procedure hemorrhage in acute stroke patients on DOACs compared to those not on DOACs. Methods: For this retrospective single-center study on prospectively collected data, we selected consecutive acute stroke patients presenting between 2016-2018. We compared the relative frequency of distal occlusions (second order vessel segments and beyond), mechanical thrombectomy, and post-procedure intracerebral hemorrhage for DOAC-users and non DOAC-users using Chi-square.Results: 60/499 (12%) acute stroke patients were on a DOAC and 439/499 (88%) were not on a DOAC (mean NIHSS 13 and 11 respectively, p=0.15). 38/60 (63%) DOAC-users had an intracranial occlusion versus 252/439 (57%) of the non DOAC-users (p=0.38). Thirty DOAC-users (50%) had a proximal occlusion compared to 160/439 non DOAC-users (36%, p=0.04). 23/60 (38%) DOAC-users underwent mechanical thrombectomy versus 139/439 (32%) non DOAC-users (p=0.21). None of the DOAC-users and two of the non DOAC-users had post-procedure intracerebral hemorrhage (p=0.49). The mean 24h-NIHSS was similar for DOAC-users as for non DOAC-users (9 and 8 respectively, p=0.72).Conclusion: DOAC-users have more often a proximal occlusion than non DOAC-users with a similar proportion of patients being offered mechanical thrombectomy, though with a tendency towards a lower risk of post-procedure intracerebral haemorrhage.