title: Rapid Systematic Review: Intra-Arterial Thrombectomy ("Clot Retrieval") for Selected Patients with Acute Ischemic Stroke.
abstract: BACKGROUND
  Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have "large vessel" strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA). The current rapid systematic review provides practicing emergency physicians updated information regarding mechanical thrombectomy as a treatment option for carefully selected AIS patients.
  
  
  METHODS
  A PubMed literature search was conducted from January 1996 to June 2016 and limited to human clinical trials written in English with relevant keywords. High-quality randomized controlled studies identified then underwent a structured review.
  
  
  RESULTS
  In total, 179 papers fulfilling the search criteria were screened and 8 appropriate articles were rigorously reviewed in detail and recommendations given on the effectiveness and indication of mechanical intra-arterial thrombectomy for the treatment of AIS.
  
  
  CONCLUSIONS
  Mechanical intra-arterial thrombectomy reduces long-term disability in a properly selected subset of patients who have an AIS caused by large vessel occlusion. Many of these patients will have failed to improve after intravenous administration of t-PA, and mortality is not increased when combined with t-PA. Careful screening criteria should be in place to identify the limited subset of patients to whom this therapy is delivered to derive optimal treatment benefits.
authors.affiliation: Departments of Emergency Medicine and Neurology, University of Michigan, Ann Arbor, Michigan.
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.affiliation: Department of Emergency Medicine, University of Kansas Hospital, Kansas City, Kansas.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Barth
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Gary
authors.initials: G
authors.lastname: Gaddis
authors.affiliation: Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California.
authors.forename: Samuel H F
authors.initials: SH
authors.lastname: Lam
mesh_terms: D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D061185:Mechanical Thrombolysis / Q000379:methods* / Q000592:standards*; D010960:Plasminogen Activators / Q000494:pharmacology / Q000627:therapeutic use; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents; D010960:Plasminogen Activators
keywords: acute ischemic stroke; mechanical intra-arterial thrombectomy; rapid review