Early recanalization of a thrombosed cerebral artery in a patient with acute
ischemic stroke is related to better outcome and reduced mortality. Intravenous
administration of rt-PA within 4.5 hours from stroke onset is the recommended therapy
for acute ischemic stroke. However, several studies demonstrated improvements, in
terms of anatomical and clinical results when intravenous therapy is associated with
intra-arterial approach. Although improvement in outcome of patients treated by
mechanical approach reported in various case series, three recent randomized controlled
failed to demonstrate the superiority of mechanical thrombectomy over intravenous
fibrinolysis. In the first part of this chapter we report the results of these randomized
trials and discuss their biases and limitations. We then describe stentriever
thrombectomy techniques and the mechanical approach to tandem occlusions.
Keywords: Embolectomy, endovascular treatment, intracranial revascularization,
intravenous fibrinolysis, ischemic stroke, mechanical treatment, tandem occlusions,
thrombectomy, stentrievers.
