A review of mechanical thrombectomy techniques for acute ischemic stroke

Abstract

Mechanical thrombectomy is established as standard of care in the management of acute ischemic stroke due to large vessel occlusion and evidence-based guidelines for mechanical thrombectomy have been defined. As research continues to further expand the eligibility criteria for thrombectomy and the number of thrombectomy procedures increase worldwide, there is also growing focus on innovation of thrombectomy devices, procedural techniques, and related outcomes. Thrombectomy primarily involves use of stent retrievers and distal aspiration techniques, but variations and different combinations of techniques have been reported. As this is a rapidly evolving area in stroke management, there is debate as to which, if any, of these techniques leads to improved clinical outcomes over another and there is a lack of data comparing them. In this review, currently published and distinct techniques of mechanical thrombectomy are described methodically along with illustrations to aid in understanding the subtle differences between the techniques. The perceived benefits of each variation are discussed.

Mechanical thrombectomy using the retrograde semi-retrieval technique for patients with underlying intracranial atherosclerotic stenosis

“…In the context of ongoing innovations in thrombectomy devices, the primary objective of thrombectomy should be to achieve complete revascularization with as few passes as possible. Nevertheless, an optimal EVT technique consensus, particularly in ICAS patients, is yet to be established (23). A prior report suggested the use of ADAPT for the initial attempt due to its association with higher reperfusion rates, increased positive outcomes, and reduced hemorrhagic complications.…”

Endovascular Thrombectomy for Acute Ischemic Stroke : Current Concept in Management

“…Achieving complete or near-complete reperfusion has been linked to better clinical outcomes and fewer adverse effects. Meanwhile, the proliferation of numerous variations and hybridizations of the technique has made it challenging for operators to select the appropriate technique for specific situations [ 68 ].…”

“…Efforts to enhance the likelihood of successful reperfusion have led to combination techniques involving stent retrievers and large-bore aspiration catheters. When combined with proximal aspiration or flow arrest using a balloon guiding catheter, the technique commonly known as the Solumbra technique has undergone significant modifications and adaptations, resulting in heterogeneity in its application and outcomes [ 68 ]. Although reported rates of successful reperfusion (TICI ≥2b) have reached nearly 100%, this has resulted in a low level of evidence for each individual technique based on single-center experiences [ 57 , 103 ].…”

Devices and Techniques

“…Recognizing the strengths and limitations of both SR and CA thrombectomy, a combined technique has been getting more popular to have synergistic effect with both the aspiration catheter and SR to maximize treatment efficacy. [10][11][12][13][14][15][16] This method usually involves initial clot engagement with an SR deployment and followed by an aspiration catheter navigation to the clot. Many variations of combined techniques have been reported and each reported combined technique varies in the following aspects.…”