Current State of the Art in Endovascular Stroke Treatment

Following the successful completion of 5 major trials establishing the clinical efficacy of endovascular thrombectomy for ELVO in the setting of AIS, there has been a tremendous focus on identifying additional patient populations that may benefit from the intervention. Improved imaging modalities and subsequent trials found thrombectomy to be highly efficacious in patients presenting up to 24 hours after stroke onset, particularly with good collaterals and large penumbral regions. Iterative catheter and device development have improved the safety profile and enhanced the efficacy of the procedure with the introduction of balloon-guide catheters, larger bore navigable aspiration catheters, and smaller catheters and devices to access medium and distal vessel occlusions. While trials are ongoing to assess the utility of thrombectomy in patients presenting with large core infarcts, distal occlusions, and direct aspiration as a first-line approach, the highly effective nature of thrombectomy for ELVO is continuing to drive the field of endovascular stroke care forward.