Interventional management of acute ischemic stroke: a systematic review.

OPINION STATEMENT: Historically, acute ischemic stroke (AIS) trials defined syndromes according to acute clinical presentation and post-ictus parenchymal imaging. With improvements in real-time arterial imaging, modern AIS treatment demands a structural approach based upon the level of cerebrovascular occlusion. The poor concordance of presenting National Institute of Health Stroke Scale (NIHSS) with vessel occlusion in recent trials bespeaks the need for an anatomic perspective. Specifically, patients with large-vessel occlusion (LVO) represent a distinct entity with a poorer prognosis than general AIS patients. Ongoing clinical trials and therapeutic strategies must recognize the varied natural history of AIS patients. Endovascular therapy offers promise in patients with the most severe strokes.