The stroke physician community witnessed a major "breakthrough" in acute stroke therapeutics when the results of the first of the many positive trials, "MR CLEAN," were published showing a significant absolute benefit in favor of mechanical thrombectomy in patients with large vessel occlusion (LVO). Thereafter, the investigators of ESCAPE, SWIFT PRIME, REVASCAT, THRACE, and PISTE concluded the same. Based on the initial studies, the American Stroke Association amended the 2013 guidelines in 2015 to include mechanical thrombectomy as the standard of care in patients with LVO presenting within six hours. In the past year, the horizon was further expanded when two major landmark trials, DAWN and DEFUSE 3, established the benefit of mechanical thrombectomy in the delayed window period in a select group of patients. It further led to the inclusion of the delayed window period treatment strategies in the 2018 guidelines. However, there are many unanswered questions in scenarios like small deficit with LVO, borderline large core, wake-up stroke (WUS), tandem occlusion, imaging of choice, conscious sedation (CS) versus general anesthesia (GA), and choice of technique. In our review, we aim to answer these questions along with a schematic representation of current techniques used in stroke thrombectomy.

中文翻译：

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机械血栓切除术：无人接听。

当许多积极试验的第一个结果“ MR CLEAN”发表后，卒中医师社区见证了急性卒中治疗的重大“突破”，显示出对大血管闭塞患者有利于机械血栓切除术的绝对优势（ LVO）。此后，ESCAPE，SWIFT PRIME，REVASCAT，THRACE和PISTE的研究人员得出了相同的结论。根据初步研究，美国卒中协会于2015年修订了2013年指南，将机械血栓切除术作为六小时内就诊LVO患者的标准护理。在过去的一年中，当两个主要的里程碑试验（DAWN和DEFUSE 3）确立了机械性血栓切除术在部分患者的延迟窗口期中的获益时，视野得到了进一步扩展。它还导致将延迟的窗口期治疗策略纳入2018年指南。但是，在诸如LVO小缺陷，临界大核心，唤醒中风（WUS），串联闭塞，选择成像，清醒镇静（CS）与全身麻醉（GA）以及技术选择等方案中，存在许多未解决的问题。在我们的综述中，我们旨在回答这些问题以及中风血栓切除术中使用的当前技术的示意图。