Journal of Neuroradiology (2015) 42, 12—20 Available online at ScienceDirect www.sciencedirect.com REVIEW Current status of mechanical thrombectomy for acute stroke treatment Vitor Mendes Pereira a,b,c,* , Hasan Yilmaz c , Alain Pellaton c , Lee-Anne Slater a , Timo Krings a,b , Karl-Olof Lovblad c a Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada b Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada c Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, 4, 1211 Geneva, Switzerland Available online 7 February 2015 KEYWORDS Acute stroke; Endovascular treatment; Stent retriever; Thrombectomy Summary Acute ischemic stroke is a morbid and disabling medical condition with a significant social and economic impact throughout the world. Intravenous thrombolysis (IVT) has been the first line treatment for patients presenting up to 4.5 hours after symptom onset for many years. Endovascular stroke treatment has been used successfully as rescue therapy after failed IVT; in patients with contraindications to rtPA or presenting outside the 4.5-hour window. The effectiveness of IVT is high for distal thrombi but significantly lower for proximal occlusions. Endovascular treatment has been revolutionized by the evolution from intra-arterial thrombo- lysis and first generation mechanical devices to the current generation of stent retrievers and aspiration systems with large bore catheters. These devices have been associated with excel- lent revascularization, improved clinical outcomes, shorter procedure times and reduced device and procedure related complications. We report the current literature, clinical standards and perspectives on mechanical thrombectomy in acute ischemic stroke. © 2015 Elsevier Masson SAS. All rights reserved. ∗ Corresponding author. Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, 3MCL-436, 399 Bathurst Street, M5T 2S8 Toronto, Ontario, Canada. Tel.: +416 603 5800x5564; fax: +416 603 4257. E-mail addresses: vitormpbr@hotmail.com (V.M. Pereira), hasan.yilmaz@hcuge.ch (H. Yilmaz), alain.pellaton@hcuge.ch (A. Pellaton), leeanne.slater@gmail.com (L.-A. Slater), timo.krings@uhn.ca (T. Krings), karl-olof.lovblad@hcuge.ch (K.-O. Lovblad). Introduction Acute ischemic stroke (AIS) accounts for the highest mor- bidity and mortality in the aged population worldwide and is an important social and economic issue for the public health system [1,2]. AIS treatment has a potential to reverse presenting neurological deficits and improve patient’s out- come [1,3]. Its success is dependent on time and therefore requires a well-developed management strategy within local organizations [5—8]. http://dx.doi.org/10.1016/j.neurad.2014.11.002 0150-9861/© 2015 Elsevier Masson SAS. All rights reserved.