Evidence gaps in endovascular treatment of acute ischemic stroke

In this PhD thesis, current evidence gaps in endovascular treatment of acute ischemic stroke are discussed. Followed by an introduction in chapter 1, we first discuss the clinical course of acute ischemic stroke due to medium vessel occlusion in chapter 2, which is not as benign as commonly assumed. In chapters 3 and 4, we assess the combined effect of baseline variables on post-stroke outcome, namely the combined effect of age and Alberta Stroke Program Early CT Score (ASPECTS) in chapter 3, and the combined effect of age and National Institutes of Health Stroke Scale (NIHSS) in chapter 4. We found no evidence of interaction between age and ASPECTS, or age and NIHSS. We further assessed the impact of different infarct patterns and tissue specific infarct volumes on 24-hour follow-up imaging after endovascular treatment in chapter 5, and found that certain infarct patterns, such as a territorial infarct pattern, are independent strong predictors of poor outcome, even when adjusting for total infarct volume. In chapter 6, we analyzed features that distinguish patients with and without fast infarct progression, and showed that cerebral vascular anatomy seems to be the most important predictor of fast infarct progression. Chapter 8 summarizes a consensus statement on antiplatelet management for carotid stenting in the setting of endovascular treatment, and chapter 9 investigates starting points for improving in-hospital acute stroke workflow efficiency. Chapter 10 provides a summary and an outlook on future directions in acute ischemic stroke research and management.