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Review
Evolution of thrombectomy approaches and devices for acute stroke: a technical review
  1. Alejandro M Spiotta1,
  2. M Imran Chaudry2,
  3. Ferdinand K Hui3,
  4. Raymond D Turner1,
  5. Ryan T Kellogg1,
  6. Aquilla S Turk2
  1. 1Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Neuroradiology, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Alejandro M Spiotta, Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta{at}musc.edu

Abstract

While intravenous administration of tissue plasminogen activator (tPA) remains the only FDA-approved treatment modality for acute ischemic stroke, many patients do not meet the criteria for intravenous tPA and are offered intra-arterial therapy. Rapid advances in devices and approaches have marked the evolution of thrombectomy over the past decade from rudimentary mechanical disruption, followed by intra-arterial thrombolytic infusions to increasingly effective thrombectomy devices. We review the critical advancements in thrombectomy technique that have evolved and the key anatomic and technical challenges they address, from first-generation Merci retrieval systems to second-generation Penumbra aspiration systems and third-generation stent retrievers, as well as nuances of their uses to maximize their effectiveness. We also highlight more recent advances that offer patients hope for more expedient vessel recanalization.

  • Stroke
  • Thrombectomy

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