Current status of mechanical thrombectomy for acute stroke treatment

Vitor Mendes Pereira; Hasan Yilmaz; Alain Pellaton; Lee-Anne Slater; Timo Krings; Karl-Olof Lovblad

doi:10.1016/j.neurad.2014.11.002

Current status of mechanical thrombectomy for acute stroke treatment

J Neuroradiol. 2015 Feb;42(1):12-20. doi: 10.1016/j.neurad.2014.11.002. Epub 2015 Feb 7.

Authors

Vitor Mendes Pereira¹, Hasan Yilmaz², Alain Pellaton³, Lee-Anne Slater⁴, Timo Krings⁵, Karl-Olof Lovblad⁶

Affiliations

¹ Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland. Electronic address: vitormpbr@hotmail.com.
² Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland. Electronic address: hasan.yilmaz@hcuge.ch.
³ Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland. Electronic address: alain.pellaton@hcuge.ch.
⁴ Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: leeanne.slater@gmail.com.
⁵ Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: timo.krings@uhn.ca.
⁶ Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland. Electronic address: karl-olof.lovblad@hcuge.ch.

PMID: 25660218
DOI: 10.1016/j.neurad.2014.11.002

Abstract

Acute ischemic stroke is a morbid and disabling medical condition with a significant social and economic impact throughout the world. Intravenous thrombolysis (IVT) has been the first line treatment for patients presenting up to 4.5 hours after symptom onset for many years. Endovascular stroke treatment has been used successfully as rescue therapy after failed IVT; in patients with contraindications to rtPA or presenting outside the 4.5-hour window. The effectiveness of IVT is high for distal thrombi but significantly lower for proximal occlusions. Endovascular treatment has been revolutionized by the evolution from intra-arterial thrombolysis and first generation mechanical devices to the current generation of stent retrievers and aspiration systems with large bore catheters. These devices have been associated with excellent revascularization, improved clinical outcomes, shorter procedure times and reduced device and procedure related complications. We report the current literature, clinical standards and perspectives on mechanical thrombectomy in acute ischemic stroke.

Keywords: Acute stroke; Endovascular treatment; Stent retriever; Thrombectomy.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Cerebral Angiography / methods*
Evidence-Based Medicine
Humans
Mechanical Thrombolysis / instrumentation*
Mechanical Thrombolysis / methods*
Stroke / diagnosis*
Stroke / therapy*
Surgery, Computer-Assisted / methods*
Treatment Outcome