Mechanical Thrombectomy for All LVO – Is It Feasible? – Recent Evidence to Expand the Current Stroke Guidelines

Abstract

Mechanical thrombectomy (MT) has established its role as a standard care of acute ischemic stroke due to large vessel occlusion (LVO). Current early stroke management guidelines have defined certain selection criteria for LVO patients undergoing MT to achieve the most benefit. However, it is still uncertain if some other LVO patients who do not meet these criteria can also benefit from MT. In this review, we research the latest evidence on efficacy and safety of MT for LVO in various unique stroke populations, such as advanced age, pre-stroke disability, LVO with minor stroke, large infarct volume, poor mismatch profile, very late time window, posterior circulation LVO and distal medium-sized vessel occlusions. By comparing the benefits and risks of MT with best medical management only, we may develop further subgroup-specific criteria to expand our capacity to best treat these unique LVO populations.