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Updated: Feb 25, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Unresolved Issues in Thrombectomy.

Mahesh V Jayaraman1,2,3,4, Ryan A McTaggart5,6,7,8, Mayank Goyal9,10

  • 1Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA. mahesh.jayaraman@gmail.com.

Current Neurology and Neuroscience Reports
|July 27, 2017
PubMed
Summary
This summary is machine-generated.

Mechanical thrombectomy (MT) significantly benefits acute ischemic stroke from large vessel occlusion (LVO). Reorganizing stroke care systems is crucial to improve access and expand MT use beyond current trial criteria for better patient outcomes.

Keywords:
Large vessel occlusionMechanical thrombectomyNeuroprotectionStrokeStroke systems of care

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Area of Science:

  • Neurology
  • Interventional Neurology
  • Stroke Medicine

Background:

  • Mechanical thrombectomy (MT) represents a major advancement in treating acute ischemic stroke caused by large vessel occlusion (LVO) in the anterior circulation.
  • Despite proven benefits, significant challenges remain in global access to MT.
  • A considerable number of LVO patients still experience disability despite current treatment advancements.

Purpose of the Study:

  • To review the established benefits of MT for LVO stroke.
  • To explore the application of MT beyond the strict criteria of major clinical trials.
  • To address systemic issues in stroke care delivery to enhance worldwide access to MT.

Main Methods:

  • Review of major randomized trials defining the efficacy of MT in LVO stroke.
  • Analysis of patient populations and treatment windows typically included in MT trials.
  • Discussion of strategies for re-organizing stroke systems of care.

Main Results:

  • Major trials focused on specific patient profiles: early symptom onset (within 6 hours), internal carotid artery (ICA) or proximal middle cerebral artery (MCA) occlusion, limited brain infarct, and significant neurological deficit.
  • Evidence strongly supports rapid revascularization with MT as improving outcomes in LVO stroke.
  • There is a recognized need to assess MT's role in patients not meeting current trial criteria.

Conclusions:

  • The efficacy of MT for LVO stroke is unequivocally established.
  • Systemic reorganization of stroke care is imperative to improve patient access to MT.
  • Further evaluation is needed to broaden the application of MT to a wider patient cohort beyond current trial parameters.