Abstract
Background: Five multi-center randomized controlled trials have shown superior outcomes for mechanical thrombectomy to standard intravenous thrombolysis for acute anterior ischaemic stroke. This idea-paper aims to provoke multi-disciplinary expertise to develop a less invasive and more rapid thrombectomy technology. The hypothesis is that by adapting existing technology to magnetize in vivo blood clots, we should be able to dislodge clots from major vessels magnetically and achieve minimally invasive reperfusion. 
 Methods: First, magnetized antibodies against specific epitopes in blood clots must be developed (such as the previously used Fibrin Beta-chain specific antibody, 59D8) and an external portable magnetic device with superlens magnetic-field focusing would be used to dislodge and guide the clot proximally to establish reperfusion; subsequently, the clot will be removed. A distal magnet, statically held at the original location of the dislodged clot, would prevent microemboli from occluding distal vessels during dislodgement and removal of the clot.
 Conclusion: Developing specific antibodies against in vivo blood clots (immunology) with attached superparamagnetic nanoparticles (nanoscience) and an external portable magnetic device with a focused magnetic flux (applied medical physics) will significantly improve time to revascularization in acute ischaemic stroke, minimize risks of intervention, and thus improve outcomes further.
Highlights
Five multi-center randomized controlled trials have shown superior outcomes for mechanical thrombectomy to standard intravenous thrombolysis for acute anterior ischaemic stroke
Several studies have shown a modest benefit of thrombectomy interventions
The Fragment crystallizable (Fc) region of the antibody would be pre-attached to superparamagnetic nanoparticles
Summary
Five multi-center randomized controlled trials have shown superior outcomes for mechanical thrombectomy to standard intravenous thrombolysis for acute anterior ischaemic stroke. This idea-paper aims to provoke multi-disciplinary expertise to develop a less invasive and more rapid thrombectomy technology. The hypothesis is that by adapting existing technology to magnetize in vivo blood clots, we should be able to dislodge clots from major vessels magnetically and achieve minimally invasive reperfusion. Acute blood clots may be visualized on ComputedTomography (CT) scans as hyperdense and radio-opaque to Xrays. Intravenous or intra-arterial thrombolysis with recombinant tissue-plasminogen activators (e.g., alteplase) have remained the gold-standard hyperacute treatment of ischaemic stroke, and previously were the standard of treatment for ST-elevation myocardial infarctions prior to primary percutaneous coronary intervention. In meta-analyses and subgroup analysis, invasive neuro-radiologically performed thrombectomies are of most
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