• Priyank Khandelwal, Dileep R Yavagal, and Ralph L Sacco.
• Department of Interventional Neuroradiology, Brigham and Women's Hospital, Boston, Massachusetts.
• J. Am. Coll. Cardiol. 2016 Jun 7; 67 (22): 2631-44.

AbstractAcute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evolution of catheter-based treatment from first-generation thrombectomy devices to the game-changing stent retrievers, results from recent trials, and the evolving stroke systems of care to provide timely access to acute stroke intervention to patients in the United States. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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