Advances in mechanical thrombectomy for acute ischaemic stroke

Area of Science:

• Neurology
• Interventional Cardiology
• Vascular Surgery

Background:

• Acute ischemic stroke due to large vessel occlusion (LVO) is a leading cause of long-term disability.
• Mechanical thrombectomy has emerged as a highly effective treatment for LVO stroke.
• Significant disparities in access to mechanical thrombectomy exist globally, creating a 'postcode lottery'.

Purpose of the Study:

• To provide a comprehensive overview of the current evidence supporting mechanical thrombectomy for acute ischemic stroke.
• To discuss recent advancements in patient selection and treatment criteria for mechanical thrombectomy.
• To highlight the ongoing challenges in accessing this critical intervention.

Main Methods:

• This narrative review synthesizes findings from pivotal clinical trials and recent studies on mechanical thrombectomy.
• It examines the evolution of treatment guidelines and expanding eligibility criteria.
• The review draws upon published literature and expert consensus regarding recanalisation therapies.

Main Results:

• Mechanical thrombectomy demonstrates superior outcomes compared to intravenous thrombolysis for LVO stroke.
• The number needed to treat for mechanical thrombectomy is favorable, comparable to interventions in other acute cardiovascular conditions.
• Evidence supporting mechanical thrombectomy has grown substantially since 2015, leading to wider adoption and refined indications.

Conclusions:

• Mechanical thrombectomy is a proven, effective treatment for acute ischemic stroke caused by LVO.
• Ongoing research and clinical practice are expanding the criteria for patient selection.
• Addressing global access inequities is crucial to ensure all eligible patients benefit from this life-saving therapy.