The evolution of personalized stroke thrombectomy

Area of Science:

• Neuroscience
• Vascular Neurology
• Interventional Neurology

Background:

• Mechanical thrombectomy is a standard treatment for acute ischemic stroke, but traditional trials limited its application to specific patient groups.
• Advances in imaging, devices, and techniques are enabling a shift towards personalized mechanical thrombectomy.
• Diverse patient populations could benefit from thrombectomy if selection criteria are broadened.

Purpose of the Study:

• To review personalization strategies in mechanical thrombectomy for acute ischemic stroke.
• To explore lesion-specific (e.g., medium vessel occlusions, basilar artery occlusions, tandem lesions) and patient-specific (e.g., infarct size, age, biomarkers) factors.
• To discuss procedural innovations and future directions for broader application.

Main Methods:

• Review of current literature on personalized mechanical thrombectomy strategies.
• Analysis of lesion-specific and patient-specific factors influencing treatment selection.
• Discussion of technological advancements and future research needs.

Main Results:

• Personalization strategies address diverse occlusions (MeVOs, BAOs, tandem lesions) and patient characteristics (infarct size, age, biomarkers).
• Procedural innovations include tailored device selection and alternative access methods.
• Challenges persist in refining selection criteria, managing risks, and ensuring equitable access.

Conclusions:

• Precision thrombectomy offers potential for wider patient applicability, improving functional outcomes.
• Further research into advanced imaging, biomarkers, and device optimization is crucial.
• Personalized approaches can reduce the global burden of stroke by expanding treatment access.