BACKGROUND: Results of initial randomised trials of endovascular treatment for @entity64 , published in 2013, were neutral but limited by the selection criteria used, early-generation devices with modest efficacy, non-consecutive enrolment, and treatment delays. RECENT DEVELOPMENTS: In the past year, six positive trials of endovascular thrombectomy for @entity64 have provided level 1 evidence for improved @entity1 outcome compared with standard care. In most @entity1 , thrombectomy was performed in addition to thrombolysis with intravenous alteplase, but benefits were also reported in @entity1 ineligible for alteplase treatment. Despite differences in the details of eligibility requirements, all these trials required proof of major @entity432 on non-invasive imaging and most used some imaging technique to exclude @entity1 with a large area of irreversibly injured brain tissue. The results indicate that modern thrombectomy devices achieve faster and more complete reperfusion than do older devices, leading to improved clinical outcomes compared with intravenous alteplase alone. The number needed to treat to achieve one additional @entity1 with independent functional outcome was in the range of 3  2-7  1 and, in most @entity1 , was in addition to the substantial efficacy of intravenous alteplase. No major safety concerns were noted, with low rates of procedural complications and no increase in symptomatic @entity1779 . WHERE NEXT?: Thrombectomy benefits @entity1 across a range of ages and levels of clinical severity. A planned meta-analysis of individual @entity1 data might clarify effects in under-represented subgroups, such as those with mild @entity64 severity or elderly @entity1 . Imaging-based selection, used in some of the recent trials to exclude @entity1 with large areas of irreversible @entity1545 , probably contributed to the proportion of @entity1 with favourable outcomes. The challenge is how best to implement imaging in clinical practice to maximise benefit for the entire population and to avoid exclusion of @entity1 with smaller yet clinically important potential to benefit. Although favourable imaging identifies @entity1 who might benefit despite long delays from symptom onset to treatment, the proportion of @entity1 with favourable imaging decreases with time. Health systems therefore need to be reorganised to deliver treatment as quickly as possible to maximise benefits. On the basis of available trial data, intravenous alteplase remains the initial treatment for all eligible @entity1 within 4  5 h of @entity64 symptom onset. Those @entity1 with major @entity432 should, in parallel, proceed to endovascular thrombectomy immediately rather than waiting for an assessment of response to alteplase, because minimising time to reperfusion is the ultimate aim of treatment.

Endovascular stent thrombectomy: the new standard of care for large vessel XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1545 :: ('MESH:D020214', 'Disease') :: ['brain injury'] @entity64 :: ('MESH:D020521', 'Disease') :: ['initial stroke', 'ischaemic stroke', 'stroke'] @entity432 :: ('MESH:D001157', 'Disease') :: ['vessel occlusion'] @entity1779 :: ('MESH:D002543', 'Disease') :: ['intracerebral haemorrhage']
@entity64 :: (MESH:D020521,Disease) :: ['ischaemic stroke']
