The Evolution of Mechanical Thrombectomy for Acute Stroke

Area of Science:

• Neurology
• Interventional Neuroradiology
• Emergency Medicine

Background:

• Acute ischemic stroke due to large vessel occlusion (LVO) historically has a poor prognosis.
• Endovascular therapy has emerged as a superior treatment option compared to medical management for selected LVO patients.
• This necessitates a comprehensive review of the stroke care pathway.

Purpose of the Study:

• To reevaluate the stroke care delivery chain in light of endovascular therapy's effectiveness for LVO.
• To define optimal patient selection criteria for endovascular therapy.
• To emphasize the importance of timely and effective treatment for eligible LVO stroke patients.

Main Methods:

• Review of clinical and radiological parameters for patient selection.
• Consideration of patients over 18 years with NIHSS score ≥ 6 within 6 hours of onset.
• Radiological criteria include LVO in ICA or MCA M1, adequate collaterals, and absence of large infarct.

Main Results:

• Endovascular therapy demonstrates superiority over medical management for appropriately selected LVO patients.
• New generation devices (stent retrievers, direct aspiration) are recommended for revascularization.
• Post-procedure monitoring in intensive care is essential, with follow-up assessments at 3 months.

Conclusions:

• Endovascular therapy is a critical advancement in treating acute ischemic stroke from LVO.
• Strict adherence to patient selection criteria is vital for optimal outcomes.
• A national effort is required to ensure all eligible LVO stroke patients receive timely and effective endovascular treatment.