Mechanical thrombectomy for the treatment of acute ischemic stroke

Abstract

Acute ischemic stroke is the leading cause of severe disability and the third leading cause of death in the USA. Intravenous tissue plasminogen activator (IV tPA) remains the most widely advocated treatment, but this therapy is limited by a narrow time window (<4.5 h after stroke onset), exclusion of patients with coagulopathy and recanalization rates of less than 50%. As a result, only 5% of acute stroke patients are treated with IV tPA. Endovascular mechanical thrombectomy may be employed, either as a standalone therapy or as an adjunct to IV tPA, and has several potential advantages, including a wider time window (up to 8 h), the capacity for use in coagulopathic patients and higher recanalization rates (up to 82%). Nonetheless, mechanical thrombectomy has engendered controversy because no randomized trials have yet been performed to support its use. In this article, we review the clinical applications of mechanical thrombectomy for the treatment of acute ischemic stroke. Ultimately, the results of ongoing trials are necessary to delineate the patient populations most likely to benefit from this therapy.

Keywords::

• acute ischemic stroke
• endovascular
• IA thrombolysis
• interventional
• intravenous thrombolysis
• mechanical thrombectomy
• recanalization

Financial & competing interests disclosure

Helmi L Lutsep received an honorarium for participating on the Boehringer Ingelheim International Advisory Board (make tPA in Europe). Gary M Nesbit has ownership interest in Concentric Medical and has served as a consultant for Concentric. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.