Biomechanics and hemodynamics of stent-retrievers

J Cereb Blood Flow Metab. 2020 Dec;40(12):2350-2365. doi: 10.1177/0271678X20916002. Epub 2020 May 19.


In 2015, multiple randomized clinical trials showed an unparalleled treatment benefit of stent-retriever thrombectomy as compared to standard medical therapy for the treatment of a large artery occlusion causing acute ischemic stroke. A short time later, the HERMES collaborators presented the patient-level pooled analysis of five randomized clinical trials, establishing class 1, level of evidence A for stent-retriever thrombectomy, in combination with intravenous thrombolysis when indicated to treat ischemic stroke. In the years following, evidence continues to mount for expanded use of this therapy for a broader category of patients. The enabling technology that changed the tide to support endovascular treatment of acute ischemic stroke is the stent-retriever. This review summarizes the history of intra-arterial treatment of stroke, introduces the biomechanics of embolus extraction with stent-retrievers, describes technical aspects of the intervention, provides a description of hemodynamic implications of stent-retriever embolectomy, and proposes future directions for a more comprehensive, multi-modal endovascular approach for the treatment of acute ischemic stroke.

Keywords: endovascular; stent-retriever; Acute ischemic stroke; large vessel occlusion; thrombectomy.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Administration, Intravenous
  • Biomechanical Phenomena / physiology*
  • Combined Modality Therapy
  • Device Removal / instrumentation*
  • Device Removal / statistics & numerical data
  • Endovascular Procedures / adverse effects
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use
  • Hemodynamics / physiology*
  • Humans
  • Ischemic Stroke / pathology
  • Ischemic Stroke / therapy*
  • Prosthesis Design
  • Randomized Controlled Trials as Topic
  • Stents / adverse effects*
  • Thrombectomy / adverse effects


  • Fibrinolytic Agents