Endovascular Therapy in Acute Ischemic Stroke: Challenges and Transition from Trials to Bedside

Rapid and effective revascularization is the mainstay of acute ischemic stroke treatment. Until recently, intravenous recombinant tissue-type plasminogen activator was the only established therapeutic option. Five recently published trials have now proven the benefit of endovascular treatment, changing dramatically the evaluation and treatment of acute ischemic stroke. Thrombectomy with stent retrievers is now recommended as the standard of care for acute ischemic strokes with a proximal large vessel occlusion in the anterior circulation. In this article, we review the current evidence on endovascular therapy in acute ischemic stroke and discuss the major challenges in the implementation of this therapy. We address the challenges of the generalizability of trial results to different patient populations, implementation of endovascular therapy in the acute setting for large populations within various geographical contexts, and approaches to evaluating future innovations in the field of neuroendovascular care.