Types of stent retrievers used in mechanical thrombectomy for acute ischaemic stroke: A scoping review

Abstract

Mechanical thrombectomy using stent retrievers is the standard endovascular treatment for acute ischaemic stroke due to large vessel occlusion. With the rapid evolution in device design, this scoping review aims to map the current landscape of stent retriever types used in clinical practice, as well as their application across different sites of vessel occlusion. A comprehensive literature search was conducted using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify primary studies reporting on the safety and efficacy of stent retrievers in mechanical thrombectomy for acute stroke. After screening and data extraction by two independent reviewers, 133 studies were included, encompassing 22 distinct stent retriever devices. Frequencies of thrombectomy procedures were analysed according to device type and occlusion location. The Solitaire and Trevo devices accounted for the majority of cases (57 %), with the most commonly treated occlusion sites being the M1 segment of the middle cerebral artery and the internal carotid artery (51 % and 19 %, respectively). In contrast, anterior cerebral artery and M3 or more distal occlusions were underrepresented, each comprising only 1 % of the data. This review highlights a strong evidence base for conventional stent retrievers in large vessel occlusions, particularly M1, while also revealing a significant gap in knowledge regarding newer generation stent retrievers and their use in distal medium vessel occlusions. Further research is needed to evaluate device safety and effectiveness in these smaller, more challenging vessels.

Keywords: Acute ischaemic stroke; Mechanical thrombectomy; Stent retriever.