Mechanical thrombectomy has been established as the standard of care for acute ischemic stroke caused by intracranial large vessel occlusion. Over the past decade, randomized trials have confirmed its efficacy, and clinical practice has rapidly disseminated. As the field matures, attention is shifting from proving effectiveness to refining techniques, understanding mechanisms underlying procedural success or failure, and extending endovascular intervention to complex vascular pathology.
Recent publications in Neurointervention during 2024–2025 reflected this transition. Together, they illustrated how the field is advancing toward precision endovascular therapy—optimizing device–clot interactions, procedural strategies, training, and preventive interventions in stroke-prone vascular conditions.
REFINEMENT OF THROMBECTOMY TECHNIQUE: RENEWED FOCUS ON STENT RETRIEVERS
Aspiration-first strategies have gained popularity in recent years, supported by advances in large-bore and flexible aspiration catheters and their expanding use in distal medium vessel occlusions [1,2]. Real-world experience with a novel small-caliber reperfusion catheter demonstrated that frontline aspiration thrombectomy can achieve high recanalization rates in M2 occlusions, whereas adjunctive stent retriever rescue remains frequently necessary to achieve complete reperfusion [3]. This emphasizes an important reality: despite the evolving aspiration technology, stent retrievers remain indispensable in daily practice.
Recent technical innovations in this journal have therefore revisited how stent retrievers can be used more effectively. The double stent retriever technique had emerged as a creative strategy to enhance the first-pass effect by improving clot coverage and engagement, particularly in complex large vessel occlusions [4]. This report demonstrated that procedural ingenuity continues to expand the technical boundaries of thrombectomy beyond conventional single-device deployment.
With increasing device utilization, attention to safety has also become essential. Although inadvertent stent retriever detachment is rare, recent case reports remind practitioners that device-related complications can still occur and may influence procedural outcomes and prognosis [5]. Highlighting this complication promotes awareness and informs the development of standardized rescue strategies.
Another often-overlooked aspect of stent retriever thrombectomy is the precise distal clot localization and optimal device–clot engagement. A novel vascular model training system using a red film to obscure thrombus visualization was introduced to simulate real-world uncertainty in clot location, allowing trainees to develop tactile recognition of clot engagement during stent deployment [6]. Such simulation-based education bridges the gap between benchtop training and real angiographic practice.
Finally, the mechanical interaction between the device and thrombus has become an important research focus. A comprehensive review summarized the evidence that thrombus composition determines stiffness, deformability, friction, and ultimately recanalization success and procedural time [7]. This mechanistic understanding provides a scientific basis for selecting thrombectomy strategies and device types tailored to thrombus properties, which is an essential step toward personalized thrombectomy.
Collectively, these contributions illustrate a renewed emphasis on stent retriever–based thrombectomy, not as a competing alternative to aspiration, but as an evolving cornerstone technology whose effectiveness depends on technique refinement, complication preparedness, and mechanistic insights.
PREVENTIVE ENDOVASCULAR INTERVENTION IN COMPLEX CAROTID PATHOLOGY
Parallel to advances in acute thrombectomy, preventive endovascular interventions for carotid pathology are undergoing reassessment. The role of carotid artery stenting in asymptomatic stenosis is being revisited internationally, emphasizing the need for refined patient selection and risk stratification [8,9].
Vessel wall imaging has emerged as a promising tool for identifying the characteristics of unstable carotid plaques. A recent study demonstrated that intraluminal thrombus on angiography and vulnerable plaque features on carotid vessel wall imaging were associated with post-procedural clinical events after carotid artery stenting [10]. These findings suggest that imaging-based risk stratification may guide preventive intervention strategies and periprocedural management.
Restenosis after carotid stenting remains a practical challenge, with no established optimal treatment. Long-term experience with cutting balloon angioplasty for in-stent restenosis showed durable luminal improvement and low recurrence rates, providing an effective therapeutic option when restenosis develops [11]. These data might offer pragmatic solutions for post-stenting management.
The carotid web has also gained recognition as a stroke-prone vascular anomaly. A recent series demonstrated that early in-hospital ultrasound surveillance could detect asymptomatic thrombus formation within carotid webs, allowing timely stenting or endarterectomy to prevent recurrent stroke [12]. This study underscores how vigilant imaging surveillance and preventive interventions may alter the natural history of previously under-recognized stroke mechanisms.
Together, these carotid-focused studies highlight a shift from uniform intervention to selective, pathology-driven preventive endovascular therapy.
TOWARD PRECISION NEUROINTERVENTION
Taken as a whole, recent stroke-related publications in Neurointervention illustrate a broader transition in the field. Endovascular stroke therapy is no longer defined simply by recanalization rates. Instead, contemporary neurointervention is evolving toward precision—matching device design to thrombus biology, refining deployment techniques through structured training, anticipating rare complications, and applying preventive interventions guided by high-resolution vascular imaging.
By revisiting these studies collectively, readers are reminded that each contribution represents not an isolated technical report, but part of an integrated progression toward safer, more effective, and more individualized endovascular care. These collective efforts will further advance technique innovation, mechanistic understanding, and evidence-based patient selection. The studies published in this journal will serve as foundational references in this ongoing evolution of precision neurointervention, shaping the future landscape of the field.
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