title: [Mechanical thrombectomy for acute ischemic stroke : current evidence and open questions].
abstract: OBJECTIVE
  To determine the importance of mechanical thrombectomy (MT) in the treatment of ischemic stroke.
  
  
  METHODS
  Analysis and comparison of randomized controlled trials (RCT) of MT versus i.v. thrombolysis (IVT) considering pathophysiological and logistic aspects.
  
  
  RESULTS
  The use of MT is more effective than IVT for internal carotid artery terminus (ICAT), M1 segment and tandem occlusions, i.e. proximal internal carotid artery (ICA) occlusion or stenosis, even in patients older than 75-80 years of age. Due to the small sample sizes this question cannot be answered for patients with M2 occlusions. It is still uncertain whether MT is needed in patients with a low National Institutes of Health stroke scale (NIHSS) score, whether IVT is needed before MT and what type of imaging should be performed. Approximately one third of eligible patients currently undergo MT in Germany. Results from RCTs with stent retrievers for patients with vertebrobasilar artery occlusions are lacking.
  
  
  CONCLUSIONS
  After becoming established as a first-line therapy for patients with ICAT, M1 segment and tandem occlusions, the effectiveness of MT with stent retrievers has to proven in patients with more distal occlusions, low NIHSS scores and even vertebrobasilar artery occlusions.
authors.affiliation: Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland. stephan.meckel@uniklinik-freiburg.de.
authors.forename: S
authors.initials: S
authors.lastname: Meckel
authors.affiliation: Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Taschner
authors.affiliation: Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: ElSheikh
authors.affiliation: Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Maurer
authors.affiliation: Klinik für Neuroradiologie, Uniklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Urbach
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D061185:Mechanical Thrombolysis / Q000401:mortality*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ischemic stroke; MR CLEAN; Solitaire; Stent retriever; Trevo