Introduction

In principle, the similarity between opening an occluded cerebral artery and an occluded coronary artery, when the perfusion to that organ is acutely compromised, is inescapable: to re-establish antegrade flow as quickly as possible to minimise downstream damage. There are, of course, important differences between an acute myocardial infarction (MI) and an acute ischaemic stroke in terms of pathophysiology, diagnosis, procedural technique and ongoing care. However, the similarities are important: the need for a sophisticated emergency network that facilitates rapid diagnosis, transportation to an appropriate facility, a team of highly trained staff capable of delivering the procedure to restore vessel flow, and appropriate in-patient and rehabilitation services. Both procedures are highly effective at improving outcomes, but successful mechanical thrombectomy (MT) for stroke is particularly beneficial: the number needed to treat is just 2.6 to prevent death or major disability, the latter defined as the difference between living independently or remaining reliant on carers long term.1 The majority of patients who have a stroke, who would benefit from MT do not yet have access to this procedure.

In this article, we examine the rationale behind emergency percutaneous intervention in ischaemic stroke, the techniques involved and the evidence behind the recommendation that this treatment should now be considered in all adults presenting within 24 hours of symptoms consistent with a large vessel occlusion (LVO).2 In the second part of this overview, we discuss the patient pathway and, in particular, the barriers that remain to suitable patients having universal access to effective treatment. Some solutions may lie in the use of existing sophisticated networks for primary angioplasty …