In this chapter, we focus on the recently published randomized controlled
trials examining combined endovascular therapy with IV tPA versus IV tPA alone. In
October 2014, the first evidence was presented from a randomized clinical trial
conducted in the Netherlands showing the benefit of endovascular therapy in acute
ischemic stroke secondary to emergent large vessel occlusion in the anterior
circulation. Four randomized controlled trials later confirmed these results. The
advances in techniques and devices which enabled these positive findings for intraarterial
therapy, including aspiration thrombectomy, stent retrievers, and combination
strategies will be discussed herein. We will also consider where opportunities remain to
maximize favorable outcomes while minimizing costs as these recent trial results are
translated into clinical practice.
Keywords: Acute ischemic stroke, Endovascular therapy, Intra-arterial therapy,
Mechanical thrombectomy, Randomized clinical trial, Reperfusion catheter, Stent
retriever.
