Thrombectomy after intravenous thrombolysis is the new standard of care in acute stroke with large vessel occlusion

Abstract

Since the demonstration of the efficacy of intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) 20 years ago with the publication of NINDS, no medical or interventional treatment had shown further clinical benefit in acute cerebral infarction. Although three randomized trials (IMS 3 SYNTHESIS, MR RESCUE) using first-generation devices (MERCI system) failed to show benefit of intra-arterial revascularization,1–3 the therapeutic management of acute ischemic stroke has been revolutionized by the recent results of six randomized controlled trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE) comparing the usual medical management (including IV thrombolysis within 4.5 h of symptoms onset) with stent retriever thrombectomy in acute anterior ischemic stroke with proximal intracranial artery occlusion (distal internal carotid artery or proximal middle cerebral artery).4–9