Acute ischemic stroke (AIS) is the second leading cause of mortality and the third leading cause of disability worldwide¹. AIS is determined by the interruption of arterial blood flow to one or more regions of the brain parenchyma causing death of neural cells. The more time that elapses between the time of artery occlusion and revascularization by thrombus removal, the more neurons will die and thus the more severe the ultimate neurological deficit will be for the patient.

The goal of treatment is to remove the thrombus occluding the artery in order to reperfuse the brain tissue as quickly as possible. Mechanical thrombectomy (MT) consists of the mechanical removal of the thrombus using a stentriever (SR) or aspiration catheters. Although these techniques allow recanalization of the vessel in most cases², in approximately 11-29%³ of patients the thrombus cannot be removed and the artery remains occluded. First-pass recanalization of the artery has been found to positively influence patient outcome at 3 months after treatment. However, first-pass recanalization is achieved in less than 25% of cases⁴ and more than one passage is often required to remove the thrombus. The success of MT depends on several factors such as the vascular anatomy, thrombus consistency and size, thrombus location, and the interaction between the thrombus and MT devices. In clinical practice, the neurointerventionalist is not aware of the characteristics of the thrombus or its precise location and cannot predict what interaction it will have with MT devices. Therefore, it is not always possible to explain the reasons why MT was unable to remove the thrombus.

This Privat Docent thesis represents the results of the author's research, which focused on trying to understand the reasons for the success or failure of different MT techniques in thrombus removal. This research was accomplished through both the analysis of clinical data and thrombectomy procedures and in vitro studies.