Local Therapy of Acute Ischemic Stroke: Mechanical Thrombectomy

Endovascular therapy plays a pivotal role in the management of acute ischemic stroke. Inside a 4.5h time window, intra-arterial treatment should be considered if the patient is not eligible for i.v. lysis, if a long clot or occlusion of a large proximal vessel is present, and after failure of i.v. lysis. Outside the 4.5 h time window intra-arterial therapy is a primary option. Different methods of mechanical thrombectomy in arteries of the intracranial circulation have become available. Proximal systems are aspiration thrombectomy devices, which are placed immediately proximal to the occlusion. The thrombus material is manually or mechanically aspirated through the guide catheter, sometimes assisted by fragmentation of the clot using a wire. Distal systems include differently shaped clot retrievers, which range from brush- or basket- to corkscrew-like configurations. In the recent past stentretrievers are being increasingly employed. The reported recanalization rates and clinical outcome are promising. Randomized controlled trials are needed to further evaluate the clinical efficiency of these devices.