Mensah Emmanuel O, Fong Yew-Weng, Muram Sandeep, Ogilvy Christopher S, Taussky Philipp
Neurosurgical Service, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
Department of Neurosurgery, Cathay General Hospital, Taipei, Taiwan.
Front Surg. 2025 Jul 29;12:1590146. doi: 10.3389/fsurg.2025.1590146. eCollection 2025.
Stroke is a leading cause of disability and death worldwide, with acute ischemic stroke accounting for most cases. Mechanical thrombectomy is a widely accepted treatment modality in appropriately selected patients, demonstrating improved functional outcomes through safe and effective recanalization. However, traditional trials have focused on a narrow subset of patients, limiting its applicability to diverse populations who would otherwise benefit from thrombectomy. Advances in neurovascular imaging, device innovation, and procedural techniques are driving a paradigm shift toward personalized stroke thrombectomy. This review explores personalization strategies across various domains, including lesion-specific considerations such as medium vessel occlusions (MeVOs), basilar artery occlusions (BAOs), and tandem lesions, as well as patient-specific factors like infarct size, low NIHSS scores, advanced age, and unique biomarkers. Additionally, we discuss procedural innovations, such as tailored device use and alternative access strategies to address anatomical and clinical complexities. While substantial progress has been made, challenges remain in refining patient selection criteria, mitigating procedural risks, and ensuring equitable access to thrombectomy. Future directions include taking full advantage of advanced imaging modalities, incorporating biomarkers for personalized care, and optimizing thrombectomy devices to support the use of thrombectomy in underrepresented populations. Precision thrombectomy has the potential to be adapted to a broader spectrum of patients, improving outcomes and ultimately reducing the global burden of stroke.
中风是全球致残和致死的主要原因，其中急性缺血性中风占大多数病例。机械取栓术是在适当选择的患者中广泛接受的治疗方式，通过安全有效的再通显示出改善的功能结局。然而，传统试验集中于狭窄的患者亚组，限制了其对原本可从取栓术中获益的不同人群的适用性。神经血管成像、设备创新和手术技术的进步正在推动向个性化中风取栓术的范式转变。本综述探讨了各个领域的个性化策略，包括病变特异性因素，如中型血管闭塞（MeVO）、基底动脉闭塞（BAO）和串联病变，以及患者特异性因素，如梗死面积、低美国国立卫生研究院卒中量表（NIHSS）评分、高龄和独特的生物标志物。此外，我们讨论了手术创新，如定制设备的使用和替代入路策略，以应对解剖和临床复杂性。虽然已经取得了重大进展，但在完善患者选择标准、降低手术风险和确保公平获得取栓术方面仍存在挑战。未来的方向包括充分利用先进的成像模式、纳入生物标志物以实现个性化护理，以及优化取栓设备以支持在代表性不足的人群中使用取栓术。精准取栓术有可能适用于更广泛的患者群体，改善结局并最终减轻全球中风负担。
