title: Mechanical Thrombectomy in Stroke.
abstract: BACKGROUND
  The introduction of neurological stroke units and of thrombolysis with the intravenous (IV) administration of recombinant tissue-type plasminogen activator (tPA) have markedly improved the treatment of stroke. Five randomized trials of catheter-based interventional treatment of stroke with special stents were published in 2015.
  
  
  METHODS
  Recently published randomized trials of mechanical thrombectomy are selectively reviewed.
  
  
  RESULTS
  These trials documented the clinical efficacy of mechanical thrombectomy (MT) in the treatment of occlusion of a major cerebral artery in the distribution of the internal carotid artery (evidence level 1a, recommendation grade A). Roughly 4-10% of all stroke patients could benefit from such an intervention. In the trials, 85% of the patients were first treated with IV-tPA. A recanalization of the occluded vessel was achieved by MT in 59-88% of patients. The percentage of patients with no deficit or only a mild deficit was 33-71% among those who received the intervention, compared to 19-40% in the control groups. The trial data indicate that MT is effective for elderly patients as well (age over 80). Thrombectomy did not increase the rate of secondary, symptomatic intracranial hemorrhage.
  
  
  CONCLUSIONS
  MT can only be used to treat the occlusion of major cerebral arteries. In appropriate patients, it expands the spectrum of treatment options for stroke. Long-term data are not yet available.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Universitätsklinikum, Hamburg-Eppendorf (UKE), Department of Neurology, Universitätsklinikum Hamburg-Eppendorf (UKE).
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control*; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome