New strategies for endovascular recanalization of acute ischemic stroke.

Although intravenous thrombolysis with recombinant tissue plasminogen activator is a proven effective therapy for acute ischemic stroke, it is often insufficient to achieve recanalization in patients with large intracranial artery occlusions. In these cases, intra-arterial reperfusion techniques may be useful. Intra-arterial thrombolysis has been largely replaced by mechanical thrombectomy as the preferred endovascular approach. Rapid technological advances have led to the development and refinement of various neurothrombectomy devices. This article reviews the evolution of neuroendovascular approaches for the management of severe acute ischemic stroke, including evidence from the main trials evaluating clinical and angiographic outcomes after neurothrombectomy.