Big and bigger data in endovascular stroke therapy

More than 30 years after initial reports demonstrated the feasibility of intra-arterial or endovascular therapies for the treatment of acute ischemic stroke, big data have finally established requisite evidence for the safety and efficacy of thrombectomy. Cautious enthusiasm for this breakthrough is tempered, as we await the bigger data of these trials to understand the constellation of variables that ensured success. Noninvasive imaging, including multimodal computed tomography and MRI as used in recent endovascular trials, has dramatically advanced since that time, providing snapshots or profiles of the collaterome in a given patient. Data-driven analyses will provide the most potent argument to distinguish comprehensive stroke centers from interventional-ready sites. These trials may provide insight on the future role of telestroke, for intravenous thrombolysis and remote imaging review of multimodal computed tomography or MRI to streamline patient transfer for endovascular therapy. Rather than concluding that recent trials have answered the most important question regarding endovascular therapy, even more data are needed to effectively translate such success and extend such potential benefit to the greatest number of stroke patients encountered on a daily basis.