Mechanical Thrombectomy: Review

Abstract

Large vessel occlusion stroke contributes to disability and mortality out of proportion to its incidence. Over time it was noted that intravenous thrombolysis alone was not sufficient for this stroke type. Slowly, endovascular approach and mechanical clot retrieval have come out to be the biggest advances in the field of neurology as well as modern medicine. Although the careful selection of patients is needed as standardized by landmark trials. At the same time, thrombectomy is now being studied in patients excluded by previous trials and is seemingly coming out be effective in the vast majority of patients with large vessel occlusions. Further, techniques and devices are getting refined day by day to achieve the maximum possible benefit.

Keywords: Ischemic stroke; mechanical thrombolysis; thrombectomy; thrombolytic therapy.

Figure 1

Important outcomes of randomized trials; Successful recanalization defined as modified TICI 2b or 3 (ESCAPE*- TICI2b or 3), Symptomatic hemorrhage definition used- † ECASS 2, ‡ ECASS, § SITS MOST, || ECASS 3 (not specified in EASI)

Figure 2

(1)- Stent retriever with a balloon guide catheter, (2) stent retriever with an aspiration catheter, (3) recanalization of basilar occlusion with ADAPT followed by stent retriever thrombectomy for superior cerebellar artery occlusion. SR- stent-retriever, MC- microcatheter