An historical and contemporary review of endovascular therapy for acute ischemic stroke

Long standing, evidence based approved therapies for acute ischemic stroke include intravenous thrombolysis therapy (IVT) with alteplase (recombinant tissue plasminogen activator, rtPA) given within 4.5 h; aspirin therapy within 48 h; management in an acute stroke unit and hemicraniectomy in cases of malignant infarction. Multiple recent positive randomized controlled trials (RCTs) have now also established endovascular therapy with mechanical thrombectomy as the standard of care for acute ischemic stroke involving a large vessel occlusion in the anterior circulation. This article will review the history of endovascular treatments for acute ischemic stroke and will review the recent positive and negative randomized controlled trial evidence for its efficacy. Current guidelines and dilemmas regarding appropriate patient selection will be discussed.