title: Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence.
abstract: Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years.
  
  
  
  Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published.
  
  
  
  These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6.
  
  
  
  The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for stroke patients.
authors.affiliation: a Second Department of Neurology , Attikon University Hospital , Athens , Greece.|b School of Medicine , University of Athens , Athens , Greece.|c Department of Neurology , University of Tennessee Health Science Center , Memphis , TN , USA.|d International Clinical Research Center , St. Anne's University Hospital in Brno , Brno , Czech Republic.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: a Second Department of Neurology , Attikon University Hospital , Athens , Greece.|b School of Medicine , University of Athens , Athens , Greece.|e Stroke Unit , Metropolitan Hospital , Athens , Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Safouris
authors.affiliation: f Department of Neurology , St. Josef-Hospital , Bochum , Germany.|g Medical Faculty , Ruhr University , Bochum , Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
authors.affiliation: h Department of Neurosurgery , Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
authors.affiliation: c Department of Neurology , University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures; D006801:Humans; D015424:Reperfusion; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy
keywords: Ischemic stroke; endovascular; intravenous thrombolysis; mechanical thrombectomy; reperfusion therapy; stent retriever