Current and Investigational Reperfusion Strategies in Acute Ischemic Stroke

Reperfusion Approaches
Recanalization or antegrade
IV and/or IAT	Thrombolytic agents: plasminogen activators, direct fibrinolytics, fibrinogenolytic agents; adjunctive therapy: heparin, direct thrombin inhibitors, GP IIb/IIIa antagonists
Endovascular thrombectomy	Distal devices: Merci,* Phenox, Neuronet, Catch, Attractor-18; proximal devices: Alligator, In-Time Retriever, snares
Endovascular thromboaspiration	Penumbra,* AngioJet, F.A.S.T. Funnel Catheter
Mechanical thrombus disruption	Microguidewire, snares, balloon angioplasty, OmniWave
Transcranial or endovascular augmented fibrinolysis	Transcranial Doppler, EKOS MicroLysUS, OmniWave
Endovascular thrombus entrapment	SES and balloon-expandable stents
Temporary endovascular bypass	Resheathable (closed-cell) stents, ReVasc
Alternative
Global reperfusion (flow augmentation or transarterial retrograde reperfusion)	Pharmacologic: vasopressors (eg, phenylephrine); mechanical: NeuroFlo
Transvenous retrograde reperfusion (flow reversal)	Partial: retrograde transvenous neuroperfusion; complete: ReviveFlow

Note:—IV indicates intravenous; IAI, intra-arterial thrombolysis; GP IIb/IIIa, glycoprotein IIb/IIIa; SES, self-expanding stents.

^*The Merci retriever and Penumbra systems have been approved by the FDA to “remove blood clots from the brain in patients experiencing an ischemic stroke.” The remaining drugs and devices constitute off-label and/or investigational (preclinical or clinical) usage.