Perfecting the Skills in Mechanical Thrombectomy

The burden of stroke is ever increasing, and gradually, it is more frequently being encountered even in younger population. Amongst the Indian population too, the incidence of stroke is increasing fast. At the pinnacle of evidence-based medicine, mechanical thrombectomy is a great achievement for our field with proven results for stroke patients. We are now obligated to offer this highly efficacious treatment to all eligible patients at every hour of every day. In addition, the treatment is a complex neurointerventional procedure. There is a massive amount of data supporting the notion of ‘time is brain’. In addition, we know from the HERMES collaboration and other datasets that the quality of reperfusion is directly related to patient outcome. The field is expanding at an unforeseen pace (for most big centres, endo-vascular thrombectomy (EVT) is now the most common neurointervention procedure); there is an expectation to provide the service at all times and additionally, open the vessel fast while keeping the complication rate minimal. There have been all kinds of innovations that have already happened from the time of the trials, and these are likely to continue for several more years. However, some things are going to remain relatively static: Human anatomy, the stress of doing a complex procedure quickly, the artefacts and challenges of doing procedures when the patient is not still, the location of the occlusion and the interpretation of imaging. The principles of thrombectomy might slightly evolve, but are expected to remain largely the same. This review article is an honest attempt to cover the entire breadth of diversity of patient presentations, anatomical variations, intra-procedural problems and their solutions.