[Mechanical thrombectomy for acute ischemic stroke : current evidence and open questions]

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• Ischemic stroke remains a leading cause of disability worldwide.
• Mechanical thrombectomy (MT) has emerged as a critical treatment for acute ischemic stroke.
• Intravenous thrombolysis (IVT) is the standard initial therapy for eligible patients.

Purpose of the Study:

• To evaluate the efficacy and importance of mechanical thrombectomy (MT) in treating ischemic stroke.
• To compare MT with intravenous thrombolysis (IVT) based on randomized controlled trials (RCTs).
• To analyze pathophysiological and logistic factors influencing MT outcomes.

Main Methods:

• Systematic review and comparison of randomized controlled trials (RCTs).
• Analysis focused on MT versus i.v. thrombolysis (IVT).
• Consideration of pathophysiological and logistic aspects of treatment.

Main Results:

• MT demonstrates superior efficacy over IVT for internal carotid artery terminus (ICAT), M1 segment, and tandem occlusions.
• MT is effective even in elderly patients (over 75-80 years).
• Efficacy for M2 occlusions remains uncertain due to small sample sizes; data for vertebrobasilar occlusions are lacking.

Conclusions:

• MT is established as first-line therapy for ICAT, M1, and tandem occlusions.
• Further evidence is required to establish MT's effectiveness for distal occlusions, low NIHSS scores, and vertebrobasilar occlusions.
• The optimal use of MT, including pre-MT IVT and imaging protocols, requires further investigation.