Mechanical recanalization for acute ischemic stroke

Thrombolysis has become accepted as an effective treatment for acute ischemic stroke. However, two major problems remain: failure of recanalization and hemorrhagic complications. The combined use of mechanical recanalization techniques with thrombolytic agents occasionally may be required to improve recanalization rates and to reduce hemorrhagic complications. Percutaneous transluminal angioplasty (PTA), clot extraction utilizing retrieval devices, and clot fragmentation using energy of ultrasonic or laser vibrations and suction-creating saline jets are possible effective mechanical recanalization strategies, but mainly as a rescue therapy for patients with failed thrombolysis. However, for large artery occlusions, thrombolysis alone often results in failure of recanalization. In such cases, to minimize the total dose of thrombolytic agents and to prevent hemorrhagic complications, mechanical recanalization may be alternatively selected as the first choice of treatment. The safety and effectiveness of PTA for acute middle cerebral artery trunk occlusion has been reported using additional thrombolysis with low doses of thrombolytic agents for distal embolism by crushed fragments. Reduction of total doses of thrombolytic agents may decrease serious hemorrhagic complications, resulting in better clinical outcome.