Mechanical Thrombectomy for Acute Ischemic Stroke: Current State and Future Directions

Abstract

Purpose of review

This review summarizes significant advancements in mechanical thrombectomy (MT) to treat acute ischemic stroke after the pivotal DAWN (Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention with Trevo) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) trials. We focus on the evolution of MT over the past 5 years, highlighting critical trials and their implications for clinical practice.

Recent findings

Recent randomized clinical trials have underscored the efficacy of MT in improving functional outcomes and reducing mortality in acute ischemic stroke patients with large ischemic cores and basilar artery occlusion. The field anticipates further randomized data that could expand MT indications to include patients with low stroke severity, preexisting disabilities, medium vessel occlusion, and those presenting beyond 24 h from stroke onset. Emerging data support simplified imaging paradigms for patient selection, enhanced pre-hospital triage protocols to expedite recanalization times, and the exploration of neuroprotective agents and intraarterial thrombolytics to improve post-MT outcomes.

Summary

Mechanical thrombectomy has solidified its role as a highly effective treatment for stroke, with indications for its use continuing to broaden. Future challenges include further expanding MT indications to encompass a wider patient population, optimizing the MT care pathway, enhancing post-MT recovery, and improving access to this critical intervention.