Several devices and products have substantially changed the treatment of ischemic stroke by endovascular approach.

  Specifically in the acute phase of ischemic stroke for thrombectomy devices (stent-Retriever) recanalization have successfully achieved up to 85% of occluded vessels. However it requires a technology and logistics use, while not always successful recanalization is accompanied by clinical improvement., Morever bleeding risks are inherent in the endovascular treatment in the acute phase of stroke.

  In particular in case of bleeding associated to SAH and MAV diseases,  endovascular techniques are an option associated to minimally invasive, safe most of the time but sometimes limited to cases where the anatomy of the malformation or aneurysm allows optimal treatment. New stents with low porosity or flow-diveters  may allow treat aneurysms with radiology anatomy hostile appoach or difficult for the neurosurgical location.

 Endovascular treatment by angioplasty/stent in secondary prevention in cases of severe carotid stenosis may be an option if there is difficulty performing endarterectomy by vascular surgery. Although new materials are safer the  effective risk of restenosis continues to be higher than endarterectomy. It is necessary to identify indications but sometimes may be the only treatment option. (e.g: postradioterapy stenosis, high bifurcation or retropharingeal placement of stenosis add to large goiter or other previous cercical surgery, recurrent carotid stenosis after surgery,…)

  Treatment with intracranial angioplasty-stent of stenosis >70% is not recommended as first option despite being symptomatic, unless there are symptoms of recurrence despite proper medical treatment. SAMMPRIS trial shows a minimal benefit in cases of repetitive symptoms in spite of best medical treatment.

   The multidisciplinary discussion is essential and the key to a correct therapeutic choice