[Technological Evolution of Mechanical Thrombectomy Devices and Techniques in Endovascular Stroke Therapy:An...

Mechanical thrombectomy was established as a standard treatment for acute large-vessel occlusion (LVO) by the HERMES collaboration. Over the following decade, thrombectomy devices and techniques rapidly diversified, with a primary focus on maximizing the first-pass effect (FPE), preventing distal embolization, and addressing intracranial atherosclerotic disease (ICAD) and medium/distal vessel occlusion (MeVO/DMVO). This article categorizes devices approved under Japan's regulatory framework as of May 2026 and reviews the major techniques developed since 2014. Furthermore, drawing on findings from the 2025 DISTAL and ESCAPE-MeVO trials and the 2026 DISTALS trial, we discuss the structural shift in contemporary mechanical thrombectomy from "technical evolution" toward a "redefinition of indications."