Endovascular thrombectomy for stroke: current best practice and future goals

Area of Science:

• Neurology
• Interventional Radiology
• Stroke Medicine

Background:

• Large vessel ischaemic stroke requires rapid reperfusion for optimal outcomes.
• Recent randomized trials have established endovascular thrombectomy as a key treatment modality.
• Guideline updates worldwide reflect the proven efficacy of this intervention.

Purpose of the Study:

• To review the evidence supporting endovascular thrombectomy for large vessel ischaemic stroke.
• To identify remaining areas of uncertainty and future research directions.
• To discuss the impact of patient selection, anesthesia, and time delays on treatment outcomes.

Main Methods:

• Comprehensive review of recent randomized trials and meta-analyses.
• Analysis of clinical subgroups, including age and stroke severity.
• Evaluation of the influence of anesthesia and time delays on treatment efficacy.

Main Results:

• Endovascular thrombectomy shows robust benefit for internal carotid and proximal middle cerebral artery occlusions.
• Treatment benefits are consistent across age groups (>80 years) and stroke severities.
• Conscious sedation is generally preferred over general anesthesia.
• Delays in imaging and reperfusion negatively impact clinical outcomes, though rapid treatment can be beneficial even with longer onset-to-imaging times in select cases.

Conclusions:

• Endovascular thrombectomy is a highly effective treatment for specific large vessel occlusions.
• Further research is needed for distal occlusions and basilar artery occlusions.
• Optimizing imaging selection, minimizing time delays, and advancing reperfusion techniques are crucial for improving patient outcomes.