title: Evolution of thrombectomy approaches and devices for acute stroke: a technical review.
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.
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Spiotta
authors.affiliation: Department of Neuroradiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: M Imran
authors.initials: MI
authors.lastname: Chaudry
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ferdinand K
authors.initials: FK
authors.lastname: Hui
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Kellogg
authors.affiliation: Department of Neuroradiology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Aquilla S
authors.initials: AS
authors.lastname: Turk
mesh_terms: D006801:Humans; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*
keywords: Stroke; Thrombectomy