Mechanical Thrombectomy for Acute Ischemic Stroke: Efficacy, Safety, Extended Time Windows, and Global Access - A Narrative Review

Abstract

Purpose: In this review, our question was how well mechanical thrombectomy (MT) works in acute ischemic stroke (AIS), which patients benefit the most from this treatment, and why MT is not accesible to so many patients worldwide. We compared MT against intravenous thrombolysis (IVT), examined combination bridging therapy, explored how far the therapeutic window can be extended, and assessed its cost effectiveness. Materials and Methods: A narrative review of the literature was conducted using predefined terms we searched PubMed/PMC, ResearchGate, and Google Scholar and included only peer-reviewed, freely accessible English-language articles published between 2015 and 2025. Studies were selected based on their relevance to predefined clinical and health economic outcomes and synthesized narratively without formal pooling of statistics. Of the studies retrieved, 24 met all criteria and formed the basis of this review. Results: Adding MT as a standard of care almost doubles the chance of functional independence at 90 days (45.65% vs. 27.45%; RR 1.65) and significantly reduces overall mortality (RR 0.85). Performing MT without prior IVT is equally effective as combination bridging therapy in patients presenting directly to centers capable of performing MT. Trials like DAWN and DEFUSE-3 showed that selected patients can benefit from MT up to 24 hours, with a staggering odds ratio for functional independence of 5.01. Across healthcare systems, MT proves cost-effective, with a mean ICER around USD 12,000-14,000 per quality-adjusted life year. Nevertheless, fewer than 3 in 100 suitable patients receive MT, with an 88% access rate difference between wealthy and lower-income countries. Conclusions: MT is the most effective treatment we have for stroke caused by large artery blockage; it works, its cost effective, and the technology keeps improving. The main problem is not whether it works, its making it available to people in less developed countries with worse accesability.