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Unresolved Issues in Thrombectomy

  • Stroke (H Diener, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Trials demonstrating marked benefit of mechanical thrombectomy (MT) for acute stroke caused by large vessel occlusion (LVO) in the anterior circulation have been the most significant advance in acute ischemic stroke in the past 20 years. However, despite this marked advance, there are still many hurdles to improving access to thrombectomy worldwide. Additionally, despite these advances, a substantial portion of patients with LVO still are left disabled.

Recent Findings

The major randomized trials focused on patients within 6 h from symptom onset, with occlusion of the ICA or proximal MCA, small amount of permanently damaged brain, and a moderate to large clinical deficit. We will explore the role of thrombectomy outside of these areas, but also explore larger issues as they pertain to re-organization of stroke systems of care to improve access to this remarkable therapy.

Summary

Now that we have proven, without a shadow of doubt, that rapid revascularization with mechanical thrombectomy improves outcomes in LVO stroke, we must reorganize our systems of care to improve access and assess the role for MT outside of the patients who meet trial criteria.

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References

Papers of particular interest, published recently, have been highlighted as • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, Room 377, Providence, RI, 02903, USA

    Mahesh V. Jayaraman & Ryan A. McTaggart

  2. Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

    Mahesh V. Jayaraman & Ryan A. McTaggart

  3. Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Providence, RI, USA

    Mahesh V. Jayaraman & Ryan A. McTaggart

  4. The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, RI, USA

    Mahesh V. Jayaraman & Ryan A. McTaggart

  5. Department of Radiology, University of Calgary School of Medicine, Foothills Medical Centre, Calgary, AB, Canada

    Mayank Goyal

  6. Clinical Neurosciences, University of Calgary School of Medicine, Foothills Medical Centre, Calgary, AB, Canada

    Mayank Goyal

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  1. Mahesh V. Jayaraman
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Correspondence to Mahesh V. Jayaraman.

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Conflict of Interest

Mahesh V. Jayaraman and Ryan A. McTaggart declare that they have no conflict of interest.

Mayank Goyal reports grants from Medtronic and personal fees from Stryker and Medtronic. In addition, Dr. Goyal has a patent systems of stroke diagnosis licensed to GE Healthcare.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Jayaraman, M.V., McTaggart, R.A. & Goyal, M. Unresolved Issues in Thrombectomy. Curr Neurol Neurosci Rep 17, 69 (2017). https://doi.org/10.1007/s11910-017-0776-4

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