Authors' objectives: The results of recent studies suggest that mechanical thrombectomy combined with standard care is superior to standard care alone for the treatment of ischemic stroke in selected patients. The intention of this paper is to show under which circumstances and for which patients the mechanical thrombectomy could be a viable option for the treatment of stroke patients. Additionally, thrombectomy devices are presented. Recent guidelines, systematic reviews, recent randomised controlled trials (RCTs) and information published by the manufacturers have been examined for this purpose. There is only evidence -on the basis of RCTs- for the efficacy of stent retriever available. At least noninvasive vascular imaging should be conducted prior the thrombectomy. The mechanical thrombectomy could be an option for patients with contraindications against systemic lysis and could allow treatment after 4.5 hours after symptoms onset. The number of potentially eligible patients is reduced because in all recent RCTs exclusively patients with anterior circulation occlusion have been treated. Additional patient selection criteria (e.g. NIHSS Score above a specific value) further limit this number.

Authors' recommendations: A potential advantage of thrombectomy is that the treatment could be performed after 4.5 hours after symptoms onset. But the number of potentially eligible patients is limited, because the treatment has shown its effectiveness only in patients with anterior stroke occlusions. The effect in posterior circulation occlusions is currently unknown. Additional patient selection criteria further limit this number (e.g. NIHSS above a certain score). Stent-retrievers are the only devices which have shown superior efficacy. At least MRA or CTA should be conducted prior to thrombectomy. The qualification requirements for the performing physicians are currently unclear.

Project Status: Completed

URL for project: http://eprints.hta.lbg.ac.at/1084/

Year Published: 2016

URL for published report: http://eprints.hta.lbg.ac.at/1084/1/HTA-Projektbericht_Nr.87.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Austria

Organisation Name: Ludwig Boltzmann Institute for Health Technology Assessment

Contact Address: Ludwig Boltzmann Institute for fuer Health Technology Assessment (LBI-HTA), Garnisongasse 7/rechte Stiege Mezzanin (Top 20), 1090 Vienna, Austria. Tel: +43 1 236 8119 - 0 Fax: +43 1 236 8119 - 99

Contact Name: tarquin.mittermayr@aihta.at

Contact Email: office@aihta.at

Copyright: Ludwig Boltzmann Institut fuer Health Technology Assessment (LBI-HTA)