Back to the Basics: Thrombectomy Devices

Thrombectomy devices are essential tools in interventional radiology for restoring blood flow through the removal of intravascular thrombus. They are used across a wide range of clinical settings, including acute ischemic stroke, acute arterial ischemia, pulmonary embolism, deep vein thrombosis, and thrombosed dialysis access. Recent advancements in thrombectomy technology have improved procedural speed, safety, and success rates. Devices now vary in mechanism and design, allowing for tailored approaches based on clot composition, vessel size, and clinical urgency. The aim of this review is to provide a back-to-the-basics overview of thrombectomy devices, highlighting their core principles, advantages, limitations, and applications across vascular territories.

Publication History

Article published online:
27 January 2026

• References

• 1 Mathews S, De Jesus O. Thrombectomy. In: StatPearls. StatPearls Publishing; 2025. . Accessed November 12, 2025, at: http://www.ncbi.nlm.nih.gov/books/nbk562154/
• 2 Nogueira RG, Jadhav AP, Haussen DC. et al; DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378 (01) 11-21
• 3 Albers GW, Marks MP, Kemp S. et al; DEFUSE 3 Investigators. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378 (08) 708-718
• 4 Berkhemer OA, Fransen PSS, Beumer D. et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
• 5 Coleman CC, Krenzel C, Dietz CA, Nazarian GK, Amplatz K. Mechanical thrombectomy: results of early experience. Radiology 1993; 189 (03) 803-805
• 6 Munich SA, Vakharia K, Levy EI. Overview of mechanical thrombectomy techniques. Neurosurgery 2019; 85 (Suppl. 01) S60-S67
• 7 Spiotta AM, Chaudry MI, Hui FK, Turner RD, Kellogg RT, Turk AS. Evolution of thrombectomy approaches and devices for acute stroke: a technical review. J Neurointerv Surg 2015; 7 (01) 2-7
• 8 Heit JJ, Chaudhary N, Mascitelli JR. et al; SNIS Standards and Guidelines Committee, SNIS Board of Directors. Focused update to guidelines for endovascular therapy for emergent large vessel occlusion: basilar artery occlusion patients. J Neurointerv Surg 2024; 16 (08) 752-755
• 9 Gandhi CD, Al Mufti F, Singh IP. et al; Standards and Guidelines committee of the Society of NeuroInterventional Surgery (SNIS). Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of Neurointerventional Surgery. J Neurointerv Surg 2018; 10 (03) 315-320
• 10 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 2019; 140 (20) e774-e801
• 11 Kasirajan K, Haskal ZJ, Ouriel K. The use of mechanical thrombectomy devices in the management of acute peripheral arterial occlusive disease. J Vasc Interv Radiol 2001; 12 (04) 405-411
• 12 Boisseau W, Escalard S, Fahed R. et al. Direct aspiration stroke thrombectomy: a comprehensive review. J Neurointerv Surg 2020; 12 (11) 1099-1106
• 13 Alawieh A, Chatterjee AR, Vargas J. et al. Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size. Neurosurgery 2020; 86 (01) 61-70
• 14 Nguyen TN, Dabus G, McGuinness B. et al. SUMMIT MAX: a randomized trial of the super large bore HIpoint reperfusion system versus vecta system for aspiration thrombectomy. Stroke 2025; 56 (08) 1980-1990
• 15 Maleux G. Management of thrombosed dialysis access circuits. Cardiovasc Intervent Radiol 2023; 46 (09) 1162-1167
• 16 Goktay AY, Senturk C. Endovascular treatment of thrombosis and embolism. Adv Exp Med Biol 2017; 906: 195-213
• 17 Stead LG, Gilmore RM, Bellolio MF, Rabinstein AA, Decker WW. Percutaneous clot removal devices in acute ischemic stroke: a systematic review and meta-analysis. Arch Neurol 2008; 65 (08) 1024-1030
• 18 Turk III AS, Siddiqui A, Fifi JT. et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019; 393 (10175): 998-1008
• 19 Lapergue B, Blanc R, Costalat V. et al; ASTER2 Trial Investigators. Effect of thrombectomy with combined contact aspiration and stent retriever vs stent retriever alone on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER2 randomized clinical trial. JAMA 2021; 326 (12) 1158-1169
• 20 Lookstein RA, Konstantinides SV, Weinberg I. et al; STORM-PE Trial Investigators. Randomized controlled trial of mechanical thrombectomy with anticoagulation versus anticoagulation alone for acute intermediate-high risk pulmonary embolism: primary outcomes from the STORM-PE trial. Circulation 2026; 153 (01) 21-34
• 21 Jaber WA, Gonsalves CF, Stortecky S. et al; PEERLESS Committees and Investigators*. Large-bore mechanical thrombectomy versus catheter-directed thrombolysis in the management of intermediate-risk pulmonary embolism: primary results of the PEERLESS randomized controlled trial. Circulation 2025; 151 (05) 260-273
• 22 Balloon Guide Catheter Versus Non–Balloon Guide Catheter. A MR CLEAN Registry Analysis | Stroke: Vascular and Interventional Neurology. Accessed August 26, 2025, at: https://www.ahajournals.org/doi/10.1161/svin.123.001103
• 23 Liu J, Zhou Y, Zhang L. et al; PROTECT-MT Investigators. Balloon guide catheters for endovascular thrombectomy in patients with acute ischaemic stroke due to large-vessel occlusion in China (PROTECT-MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial. Lancet 2024; 404 (10468): 2165-2174
• 24 Happi Ngankou E, Gory B, Marnat G. et al; ETIS Registry Investigators†. Thrombectomy complications in large vessel occlusions: incidence, predictors, and clinical impact in the ETIS registry. Stroke 2021; 52 (12) e764-e768
• 25 Mokin M, Fargen KM, Primiani CT. et al. Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 2017; 9 (10) 922-928
• 26 Masoud H, Nguyen TN, Martin CO. et al. Inadvertent stent retriever detachment: a multicenter case series and review of device experience FDA reports. Intervent Neurol 2016; 4 (3-4): 75-82
• 27 2B, 2C, or 3 | Stroke. Accessed August 26, 2025, at: https://www.ahajournals.org/doi/10.1161/strokeaha.119.028891
• 28 Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ischaemic stroke. Stroke 2021; 52 (03) 1131-1142
• 29 Molad J, Honig A. Current advances in endovascular treatment. Curr Opin Neurol 2023; 36 (02) 125-130
• 30 Campbell BC. Hyperacute ischemic stroke care-current treatment and future directions. Int J Stroke 2024; 19 (07) 718-726
• 31 Piscopo A, Zanaty M, Dlouhy K. Contemporary methods for detection and intervention of distal medium and small vessel occlusions. J Clin Med 2023; 12 (18) 6071