Assessing the efficacy of endovascular therapy in stroke treatments: updates from the new generation of trials.

INTRODUCTION: For the past 20 years, intravenous recombinant tissue plasminogen activator (rt-PA) has been the only proven treatment for acute ischemic stroke. Large arteries such as the internal carotid artery, the middle cerebral artery and the basilar artery supply blood to large volumes of brain tissue. When occluded, these vessels may have low response rates to rt-PA resulting in devastating injury and death. Areas covered: In 2013, three trials evaluating the efficacy of mechanical thrombectomy in acute stroke were neutral, however, lessons learned from these trials resulted in a second generation of five trials in 2015 and a sixth in 2016 which all demonstrated significant benefit for select patients. Here we will review the evidence behind these new trials and. introduce new questions such as models of care, techniques of thrombectomy, the role of rt-PA, modes of anesthesia, the management of late presenting and wake up strokes among other real world challenges facing stroke medicine now that the thrombectomy is an evidence based treamtnent Expert commentary: The mechanical thrombectomy is now the new standard of care and with that comes the need to find ways to provide it to all who will benefit.