In the previous chapters, the intravenous (IV) as well as intra-arterial (IA) thrombolysis for acute ischemic stroke (AIS) have been discussed. In this chapter, we will move on to discuss mechanical thrombectomy for acute ischemic stroke. Mechanical thrombectomy has been around for over a decade now. There have been tremendous advances in the device technology over this time. We will discuss briefly mechanical thrombectomy and its evolution over the last few years especially in the field of stent technology in mechanical thrombectomy for AIS. We will then briefly discuss the current evidence for mechanical thrombectomy in AIS and then move on to discuss the general principles and the technique and practical considerations of stent retriever thrombectomy. The words “mechanical thrombectomy” and “endovascular thrombectomy” are used interchangeably in this chapter.
Mechanical thrombectomy involves the use of mechanical devices to aid in achieving recanalization of an occluded vessel. The mechanical thrombectomy can be done as a primary or secondary modality of treatment for acute ischemic stroke. Based on the location of the device with respect to thrombus at the time of thrombectomy, they can be classified into proximal systems (Penumbra, AngioJet), distal systems (MERCI, Catch, Lazarus, etc.), and on the spot systems (stents, stent retrievers).
The chief advantages of mechanical thrombectomy include their ability to achieve faster and more efficient revascularization in addition to having an extended therapeutic time window from symptom onset compared to IV/IA thrombolytics alone. The chief disadvantages of the mechanical thrombectomy include the additional cost of the devices, setup, the need for skilled interventionist and the support staff, and the increased risk of procedural complications like vascular perforation, fragmentation and distal migration of thrombus, etc. In the following sections, we will discuss the evolution of the mechanical thrombectomy for AIS followed by the use of stents during mechanical thrombectomy in AIS.
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