Journal
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 40, Issue 12, Pages 2350-2365Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X20916002
Keywords
Acute ischemic stroke; endovascular; large vessel occlusion; stent-retriever; thrombectomy
Categories
Funding
- Cerenovus
- Medtronic Neurovascular
- Stryker Neurovascular
- National Institutes of Health (NIH)
- United States - Israel Binational Science Foundation
- Anaconda
- Apic Bio
- Arsenal Medical
- Axovant
- Ceretrieve
- Cook Medical
- Galaxy LLC
- Gentuity
- Imperative Care
- InNeuroCo
- Insera
- Magneto
- Microvention
- MIVI Neurosciences
- Neuravi
- Neurogami
- Philips Healthcare
- Progressive Neuro
- Rapid Medical
- Route 92 Medical
- Syntheon
- Wyss Institute
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In 2015, multiple randomized clinical trials showed an unparalleled treatment benefit of stent-retriever thrombectomy as compared to standard medical therapy for the treatment of a large artery occlusion causing acute ischemic stroke. A short time later, the HERMES collaborators presented the patient-level pooled analysis of five randomized clinical trials, establishing class 1, level of evidence A for stent-retriever thrombectomy, in combination with intravenous thrombolysis when indicated to treat ischemic stroke. In the years following, evidence continues to mount for expanded use of this therapy for a broader category of patients. The enabling technology that changed the tide to support endovascular treatment of acute ischemic stroke is the stent-retriever. This review summarizes the history of intra-arterial treatment of stroke, introduces the biomechanics of embolus extraction with stent-retrievers, describes technical aspects of the intervention, provides a description of hemodynamic implications of stent-retriever embolectomy, and proposes future directions for a more comprehensive, multi-modal endovascular approach for the treatment of acute ischemic stroke.
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