Mechanical thrombectomy for acute ischemic stroke

Mechanical thrombectomy for acute ischemic stroke is the endovascular retrieval of clots obstructing large intracranial vessels in acute ischemic stroke patients and has become the treatment of choice in selected individuals with acute intracranial occlusion by thromboembolism. 

Despite a number of earlier trials, it was only in 2015 that multiple randomized controlled trials showed improved clinical outcome in patients with acute stroke due to large vessel occlusion undergoing thrombectomy compared to medical (conservative) treatment alone 3-5.  

  • acute ischemic stroke due to large vessel occlusion in the anterior circulation within 6 hours of symptom onset
  • several trials (e.g. DAWN 13 and DEFUSE3 6) have shown that selected patient groups who fall outside the 6 hour time window also benefit from thrombectomy 12
  • intracranial hemorrhage on initial non-contrast CT
  • large infarct core with no significant penumbra (i.e. no salvageable brain)
  • various patient factors (e.g. pre-morbid functional status, advanced directives, etc...) 

Non-contrast enhanced CT is used to exclude hemorrhage and CT angiography to determine large vessel occlusion. Alternatively, MRI and DSA may also demonstrate the occlusion. Angiographic imaging can also assess collateral vessels which contribute to predicting outcome in some settings 8. The role of advanced imaging such as CT perfusion to determine the infarct core and penumbra size is still uncertain 10, yet the technique is being ushered into more and more centers based on international guidelines 11.

  • stent retrievers
  • aspiration devices
  • balloon guiding catheter
  • microcatheters

The overall complication rate is about 15% 1. Complications include 2,9:

The technical outcome is graded using the mTICI score. Thrombectomy is a highly effective treatment for stroke with a number needed to treat (NTT) of 2.6 for an improved functional outcome. In a meta-analysis, 46% of patients treated with mechanical thrombectomy achieved functional independence (modified Rankin scale (mRS) 0–2 at 90 days) compared to 27% for best medical treatment 2.

Stroke and intracranial haemorrhage
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Article information

rID: 57136
Synonyms or Alternate Spellings:
  • Mechanical thrombectomy for acute ischemic stroke
  • Mechanical thrombectomy
  • Endovascular clot retrieval (ECR)

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Cases and figures

  • Thrombus retrieved
    Figure 1: ICA/M1 occlusion treated with mechanical thrombectomy
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  • Occlusion of the ...
    Case 1: right MCA infarction with thrombectomy
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  • Case 2; proximal right MCA M1 segment embolic occlusion
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  • Case 3: acute left middle cerebral artery territory infarct with clot retrieval
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  • Case 4: basilar tip thrombus with endovascular clot retrieval
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  • Case 5: acute P1 occlusion treated with ECR
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