Neurointerventional therapy for large vessel occlusion stroke: the new standard of care

Abstract

For the past two decades, intravenous tissue plasminogenactivator (IV tPA) has been the gold standardtreatment of acute ischemic stroke (AIS) for patientspresenting to the hospital in the first 4.5 hours aftersymptom onset. However, in patients with AIS due tointracranial large vessel occlusion (LVO), IV tPA hasvery poor recanalization rates. This group of patientshas significantly worse outcomes than those withoutLVO. Endovascular therapy has evolved significantlysince the first trial in 1998. With the publication of recenttrials using modern stent-retriever devices andselection of patients with LVO, endovascular therapyhas become the standard of care for patients with themost severe ischemic strokes. In this article we outlinethe two decade evolution of this therapy.