Mechanical thrombectomy for AIS from large vessel occlusion – current trends and future perspectives

Abstract

Stroke is found to be one of the global top causes of mortality and the major factor in years of life with a handicap (DALYs). Ischemic strokes contributed to nearly seventy percent of all strokes worldwide. For endovascular thrombectomy (EVT) in acute ischemic stroke with large vessel obstruction (AIS-LVO). Using stent retrievers and/or reperfusion catheters has become the gold standard of therapy. The methodology involved keyword-based search in databases like PubMed, Embase, and Google Scholar for recent publications on mechanical thrombectomy, AIS, large vessel occlusion, screening relevant articles, retrieving full texts, and synthesizing key findings on procedural advancements, patient selection, COVID-19 impact, delay effects, effectiveness, clinical outcomes, and future perspectives. Only people with substantial cerebral artery obstruction may do well from mechanical thrombectomy (MT). This includes the distal carotid artery and the proximal middle cerebral artery (segment M1). The size of a blocked vessel and NIHSS score are directly connected. Both the 2018-19 versions of the AHA/ASA Guidelines for the Early Management of Patients with Acute Ischemic Stroke contained the recommendations that cases with AIS-LVO get endovascular therapy when administered during the time frame of 0 to 6 hours after onset (Grade IA evidence). It is questionable whether this group of patients can be managed without the need for intravenous tPA at the onset. When functional independence (mRS score 2) was present at long-term follow-up, the endovascular intervention was favored. Tenecteplase (TNK), which differs from alteplase in terms of genetic variation, has a greater half-life and a higher level of fibrin selectivity, enabling bolus infusion. Studies have also demonstrated its efficacy and safety, as well as its long-term cost-effectiveness.

Effectiveness of Transesophageal Echocardiography in Preventing Thromboembolic Complications Before Cardioversion: A Narrative Review

“…One of the major consequences of AFib is its link to clot-related issues and strokes [ 1 ]. Stroke is one of the top causes of mortality worldwide [ 2 , 3 ]. This heart condition raises the risk of stroke by four to six times (going up to 15 times if an individual has a history of rheumatic heart disease), making it a significant factor for strokes in the elderly and the leading cause of embolic stroke [ 1 ].…”