Yes! Thats what new research has found, both the studies MrClean and ESCAPE reports on that and other studies too, but thrombectomy is just as thrombolysys only an option for some of those who suffers a stroke caused by ischemia caused by a thromb or an emboli. You have a wider time window for treatment, but you need to know the time of onset for stroke so persons with wake-up stroke are excluded.
Also you have to consider other surgical treatment for stroke or patient with TIA like carotid endarterectomy and extracranial intracranial vascular bypass surgeries.
As long as find a thrombus to remove, it is extraordinary. No value if not. Posterior circulation is not included, but there should be ongoing trials. In embolic stroke affecting multiple territories it obviously should be difficult to impossible, too.
Intracranial thrombectomy has been around for some years with variable results. In the last 10 years an array of endovascular devices specifically designed for this scope have been developed flooding the market and making results from different case groups difficult to compare. Baskets, retrievable stents, sucking catheters and cork-screw-like devices are only some examples, some of which are still on the market and others have been dismissed. Two studies published at the beginning of the year have shown that in the appropriate settings mechanical thrombectomy con be very effective. Time windows are an important matter of debate. Several reports have tried to demonstrate that the use of advanced imaging (Mostly DWI and Perfusion) may be useful to include patients that arrive in hospital several hours after symptoms onset or with wake-up stroke. It is important to keep in mind that IV thrombolysis, IA thrombolysis and IA thrombectomy all have to be available and used each for it's own indications from a well trained and always up to date team.
YES! If the thrombectomy is performed in a timely fashion. Where available, CTP or MRP may help define viable penumbra and guide whether or not the procedure may be performed (rather than an arbitrary time window).
I'm not sure if you'll get a notification that another answer has been posted to this question...
The 5 trials published in NEJM in Spring 2015 (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) together show that acute ischemic stroke patients with imaging confirmed large vessel anterior circulation occlusions, with an ASPECTS score > 6 on initial noncontrast CT, and who were treated with a second generation mechanical thrombectomy device (a.k.a., stent-retrievers) have better functional outcomes compared to patients treated with IV alteplase alone.
A meta-analysis was published in JAMA summarizing these findings: http://jama.jamanetwork.com/article.aspx?articleid=2467553