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Current Situation and Challenges of Endovascular Treatment Strategies for Acute Ischemic Stroke

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 20 January 2026 | Viewed by 3552

Special Issue Editor

Prof. Dr. Fusao Ikawa

E-Mail Website
Guest Editor
Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane 693-8555, Japan
Interests: neurosurgery; cerebral aneurysms; acute ischemic stroke; endovascular treatment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, endovascular treatments, including thrombectomy for acute ischemic stroke, have made remarkable advancements, contributing to improved patient outcomes. Along with this, there has been a shift in awareness among emergency services and patients, allowing for quicker transportation to facilities capable of providing treatment when stroke symptoms are suspected. Healthcare providers have also been working to establish systems that enable immediate and thorough treatment. However, these efforts are still not sufficient, and various issues remain. In this Special Issue, we will examine the current situation and challenges that lie ahead.

Prof. Dr. Fusao Ikawa
Guest Editor

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Keywords

  • acute ischemic stroke
  • endovascular treatment
  • imaging
  • management of ischemic stroke
  • system and strategy for acute ischemic stroke
  • multidisciplinary approach for acute ischemic stroke

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Published Papers (3 papers)

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Research

11 pages, 217 KB  
Article
Postmarketing Surveillance of Thrombectomy Using a Tron FX Stent Retriever for Large and Medium Vessel Occlusion
by Hirotoshi Imamura, Nobuyuki Sakai, Masataka Takeuchi, Tsuyoshi Ohta, Nobuyuki Ohara, Yukako Yazawa, Yoshinori Akiyama, Maki Fukuda, Keisuke Imai, Chiaki Sakai, Yasushi Matsumoto, Yuji Matsumaru, Hiroshi Yamagami, Shinichi Yoshimura, Yasushi Ito, Naoya Kuwayama and Tatsuo Kagimura
J. Clin. Med. 2025, 14(22), 7913; https://doi.org/10.3390/jcm14227913 - 7 Nov 2025
Viewed by 472
Abstract
Background/Objectives: The Tron FX is a stent retriever thrombectomy device that underwent a clinical trial in Japan in 2016. Its key feature is the availability of a 2/15 mm model designed for medium-vessel occlusion (MeVO). This study reports the results of postmarketing [...] Read more.
Background/Objectives: The Tron FX is a stent retriever thrombectomy device that underwent a clinical trial in Japan in 2016. Its key feature is the availability of a 2/15 mm model designed for medium-vessel occlusion (MeVO). This study reports the results of postmarketing surveillance (PMS) conducted from 2019 to 2020. Methods: The PMS included data from 240 patients in whom a Tron FX was used during the first pass at 24 Japanese institutions. Occluded vessels involving the M2 and M3 segments of the middle cerebral artery, anterior cerebral artery, and posterior cerebral artery were classified as MeVO. The recanalization rate, first pass effect (FPE) rate, symptomatic intracranial hemorrhage (sICH) rate, and favorable prognosis rate at 90 days were evaluated. Treatment outcomes were also analyzed for cases in which the device was used after the second pass, excluding those with tandem occlusion, atherothrombotic brain infarction (ATBI), or percutaneous transluminal angioplasty (evaluation-appropriate cases), stratified by MeVO and large vessel occlusion (LVO) and according to Tron FX device size. Results: A total of 244 cases were enrolled, of which 218 were evaluation-appropriate. Across all cases, the recanalization rate (modified Thrombolysis in Cerebral Infarction score ≥ 2b) was 70.9%, the FPE rate was 23.4%, the sICH rate was 3.8%, and the proportion of patients with a good prognosis (modified Rankin Scale score 0–2 at 90 days) was 53.1%. Among evaluation-appropriate cases, excluding those with tandem lesions or ATBI, the corresponding rates were 72.9%, 24.8%, 6.9%, and 45.5%, respectively. When analyzed by occluded vessel type, the rates for MeVO were 71.9%, 23.7%, 6.1%, and 45.7%, respectively, while those for LVO were 74.0%, 26.0%, 7.7%, and 45.1%. According to device size, the outcomes for the 2/15 mm Tron FX were 72.9%, 23.5%, 4.7%, and 50.0%, respectively, and those for the 4/20 mm device were 72.9%, 25.6%, 8.3%, and 42.5%. Conclusions: The PMS results for the Tron FX thrombectomy device were excellent, particularly for MeVO and the 2/15 mm model. These findings suggest that the Tron FX may help improve thrombectomy outcomes in MeVO. Full article
(This article belongs to the Special Issue Current Situation and Challenges of Endovascular Treatment Strategies for Acute Ischemic Stroke)
12 pages, 746 KB  
Article
The Combination of Atrial Fibrillation and Occlusion Site Predicts In Situ Atherosclerotic Thrombosis in Basilar Artery Occlusion
by Yukishige Hashimoto, Fusao Ikawa, Reo Kawano, Toshikazu Hidaka, Yusuke Inoue, Yusuke Yamamoto and Nobutaka Horie
J. Clin. Med. 2025, 14(18), 6384; https://doi.org/10.3390/jcm14186384 - 10 Sep 2025
Viewed by 472
Abstract
Background/Objectives: The accurate evaluation of stroke etiology in basilar artery occlusion (BAO) remains underexplored. This study aimed to explore a simple and practical method for predicting the in situ atherosclerotic thrombosis (ISAT) subtype of BAO. Methods: We retrospectively analyzed patients diagnosed with [...] Read more.
Background/Objectives: The accurate evaluation of stroke etiology in basilar artery occlusion (BAO) remains underexplored. This study aimed to explore a simple and practical method for predicting the in situ atherosclerotic thrombosis (ISAT) subtype of BAO. Methods: We retrospectively analyzed patients diagnosed with BAO at our institution between April 2015 and April 2025. ISAT was characterized by moderate-to-severe stenosis (>50%) at the occlusion site on angiography, while the cardioembolism (CE) subtype was defined as sudden-onset arterial occlusion with evidence of a cardiac source of embolism. The location of BAO was classified based on cerebral angiography findings as proximal, middle, or distal. Clinical and imaging characteristics were compared between CE and ISAT subtypes. Results: Among 33 patients, 8 (24%) were classified as having the ISAT subtype. Multivariable analyses revealed that the presence of atrial fibrillation (AF) (OR 0.03; 95% CI, 0.00–0.56) and a non-proximal occlusion site (i.e., middle or distal) (OR 0.02; 95% CI, 0.00–0.27) were independently associated with ISAT. Patients were stratified into four groups based on the presence or absence of proximal occlusion and AF. CE subtypes predominated in groups with either AF or no proximal occlusion (25/27, 93%), whereas ISAT was present in all patients with both proximal occlusion and absence of AF (6/6, 100%). The area under the curve for this classification was 0.955. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing ISAT were 75%, 100%, 100%, and 93%, respectively. Conclusions: A simple classification based on the presence of proximal occlusion and AF status suggested the potential to facilitate preprocedural differentiation of ISAT subtype in BAO. Full article
(This article belongs to the Special Issue Current Situation and Challenges of Endovascular Treatment Strategies for Acute Ischemic Stroke)
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12 pages, 1002 KB  
Article
Improving Acute Ischemic Stroke Care in Kazakhstan: Cross-Sectional Survey
by Shayakhmet Makhanbetkhan, Botagoz Turdaliyeva, Marat Sarshayev, Yerzhan Adilbekov, Sabina Medukhanova, Dimash Davletov, Aiman Maidan and Mynzhylky Berdikhojayev
J. Clin. Med. 2025, 14(7), 2336; https://doi.org/10.3390/jcm14072336 - 28 Mar 2025
Cited by 3 | Viewed by 2165
Abstract
Background: Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide, with upper-middle-income countries (UMICs) facing a disproportionate burden due to systemic inefficiencies in healthcare delivery. Kazakhstan reports the highest global age-standardized mortality rate from ischemic stroke, underscoring the [...] Read more.
Background: Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide, with upper-middle-income countries (UMICs) facing a disproportionate burden due to systemic inefficiencies in healthcare delivery. Kazakhstan reports the highest global age-standardized mortality rate from ischemic stroke, underscoring the need to evaluate current stroke care practices and identify areas for improvement. Objective: This study aimed to assess the current state of acute ischemic stroke care in Kazakhstan by examining key time metrics, protocol adherence, and the utilization of advanced technologies such as artificial intelligence (AI) and telemedicine. Additionally, this study sought to identify regional disparities in care and propose actionable recommendations to improve patient outcomes. Methods: A multi-center cross-sectional survey was conducted across 79 stroke centers in Kazakhstan. Data were collected from 145 healthcare professionals, including neurologists, neurosurgeons, and interventional radiologists, through a validated 23-question online questionnaire. Statistical analysis was performed to identify significant associations between variables. Results: Significant regional disparities were observed in stroke care timelines and technology adoption. Remote and rural areas experienced prolonged prehospital delays, with transport times ranging from 120 to 180 min, contributing to door-to-needle times exceeding the recommended benchmark. Urban centers with higher adoption of AI and telemedicine demonstrated faster treatment initiation and better protocol compliance. Staff training was significantly associated with improved treatment outcomes, with trained centers more likely to implement direct-to-angiography suite protocols, reducing in-hospital delays. Conclusions: Addressing acute ischemic stroke care disparities in Kazakhstan requires a multifaceted approach, including expanding AI and telemedicine, implementing targeted staff training programs, and establishing standardized national stroke protocols. These strategies can help reduce treatment delays, bridge the urban–rural healthcare divide, and improve patient outcomes. The findings have implications for other UMICs facing similar challenges in delivering equitable stroke care. Full article
(This article belongs to the Special Issue Current Situation and Challenges of Endovascular Treatment Strategies for Acute Ischemic Stroke)
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