Modern Endovascular Treatment of Ischemic Disease

Abstract

Acute ischemic strokes still account for substantial morbidity and mortality worldwide despite decades of research aimed at reducing the burden of this disease. Since the establishment of intravenous thrombolysis as the standard of care, advances in device technology have rapidly progressed while randomized clinical trials have struggled to keep pace. Early trials were hampered by inconsistent use of technology and poor patient selection, leading to overall futility. However, a string of recent studies utilizing the most modern technology has unequivocally proven the superiority of endovascular treatment for acute ischemic strokes caused by large vessel occlusion in select patients. We describe the sequential progression of this therapeutic paradigm in parallel with the clinical trials that have proven its efficacy and identify clinical questions that remain yet unanswered.