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Neurothrombectomy in the treatment of acute ischaemic stroke

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Abstract

Major ischaemic stroke is a leading cause of morbidity and mortality in industrialized countries. For patients with acute stroke, fast and effective vessel recanalization is important for successful treatment. Neurothrombectomy—that is, angiographically performed mechanical thrombus removal from intracranial arteries—results in higher recanalization rates than with pharmaceutical thrombolysis alone, but the value of this treatment in terms of clinical outcome remains to be established. This article summarizes the history of intra-arterial stroke treatment, outlines the recent developments and the different techniques used, and discusses the results of current studies on neurothrombectomy. Owing to the high morphological and clinical variability of stroke, careful patient selection in future randomized controlled trials will be crucial for assessment of the true potential of neurothrombectomy.

Key Points

  • Intravenous thrombolysis has limited effects on outcomes in patients with acute ischaemic stroke, mainly owing to insufficient ability of this drug to dissolve large thrombi

  • Several emerging angiographic techniques that aim to remove the thrombus from an occluded cerebral artery (neurothrombectomy) are under investigation

  • Recent studies suggest that neurothrombectomy can recanalize large cerebral arteries more quickly and effectively than does intravenous thrombolysis

  • Prospective controlled trials are required to determine whether neurothrombectomy as an adjunct to established therapy results in better patient outcomes

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Figure 1: CT imaging of acute left-hemispheric stroke.
Figure 2: Cerebral angiography of neurothrombectomy.
Figure 3: Thrombus specimen retrieved by neurothrombectomy.

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Both authors researched data for the article, and made substantial contributions to discussion of the content, writing the article, and to review and/or editing of the manuscript before submission.

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Jansen, O., Rohr, A. Neurothrombectomy in the treatment of acute ischaemic stroke. Nat Rev Neurol 9, 645–652 (2013). https://doi.org/10.1038/nrneurol.2013.204

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