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Since November 2014, nine positive randomised controlled trials of mechanical thrombectomy for large vessel occlusion in the anterior circulation have led to a revolution in the care of patients with acute ischaemic stroke. Its efficacy is unmatched by any previous therapy in stroke medicine, with a number needed to treat of less than 3 for improved functional outcome. With effectiveness shown beyond any reasonable doubt, the key challenge now is how to implement accessible, safe and effective mechanical thrombectomy services. This review aims to provide neurologists and other stroke physicians with a summary of the evidence base, a discussion of practical aspects of delivering the treatment and future challenges. We aim to give guidance on some of the areas not clearly described in the clinical trials (based on evidence where available, but if not, on our own experience and practice) and highlight areas of uncertainty requiring further research.<\/jats:p>","DOI":"10.1136\/practneurol-2017-001685","type":"journal-article","created":{"date-parts":[[2017,6,24]],"date-time":"2017-06-24T20:20:13Z","timestamp":1498335613000},"page":"252-265","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":93,"title":["Revolution in acute ischaemic stroke care: a practical guide to mechanical thrombectomy"],"prefix":"10.1136","volume":"17","author":[{"given":"Matthew R B","family":"Evans","sequence":"first","affiliation":[{"name":"Stroke Research Centre, Department of Brain repair and Rehabilitation, University College London Institute of Neurology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"White","sequence":"additional","affiliation":[{"name":"Stroke Research Centre, Institute of Neuroscience and Newcastle University Institute for Ageing, Newcastle Upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Cowley","sequence":"additional","affiliation":[{"name":"Stroke Research Centre, Department of Brain repair and Rehabilitation, University College London Institute of Neurology, London, UK"},{"name":"Neuroradiological Academic Unit, University College London Institute of Neurology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Werring","sequence":"additional","affiliation":[{"name":"Stroke Research Centre, Department of Brain repair and Rehabilitation, University College London Institute of Neurology, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,6,24]]},"reference":[{"key":"2025090409381828000_17.4.252.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61953-4"},{"key":"2025090409381828000_17.4.252.2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002604"},{"key":"2025090409381828000_17.4.252.3","unstructured":"Mechanical clot retrieval for treating acute ischaemic stroke. 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