{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:57:20Z","timestamp":1768276640904,"version":"3.49.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:p>Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits\u2014Intra-Arterial (EXTEND IA), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment Trial (SWIFT PRIME), and Randomized Trial of Revascularization With the Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) studies. We review the main results of these studies and how they inform stroke patient management going forward. The main take home points for neurologists are (1) intra-arterial thrombectomy is a potently effective treatment and should be offered to patients who have documented occlusion in the distal internal carotid or the proximal middle cerebral artery, have a relatively normal noncontrast head computed tomographic scan, severe neurological deficit, and can have intra-arterial thrombectomy within 6 hours of last seen normal; (2) benefits are clear in patients receiving r-tPA before intra-arterial thrombectomy; r-tPA should not be withheld if the patient meets criteria, and benefit in patients who do not receive r-tPA or have r-tPA exclusions requires further study; and (3) these favorable results occur when intra-arterial thrombectomy is performed in an endovascular stroke center by a coordinated multidisciplinary team that extends from the prehospital stage to the endovascular suite, minimizes time to recanalization, uses stent-retriever devices, and avoids general anesthesia. In conclusion, stroke teams, including practicing neurologists caring for patients with stroke should now provide the option for intra-arterial thrombectomy for a subset of patients with acute stroke.<\/jats:p>","DOI":"10.1161\/strokeaha.115.008384","type":"journal-article","created":{"date-parts":[[2015,5,6]],"date-time":"2015-05-06T03:01:58Z","timestamp":1430881318000},"page":"1447-1452","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":106,"title":["Stroke Neurologist\u2019s Perspective on the New Endovascular Trials"],"prefix":"10.1161","volume":"46","author":[{"given":"James C.","family":"Grotta","sequence":"first","affiliation":[{"name":"From the Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); and Department of Neurology, University Hospital Heidelberg, Ruprecht-Karls University, Heidelberg, Germany (W.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werner","family":"Hacke","sequence":"additional","affiliation":[{"name":"From the Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); and Department of Neurology, University Hospital Heidelberg, Ruprecht-Karls University, Heidelberg, Germany (W.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60768-5"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15692-4"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60491-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199710303371812"},{"key":"e_1_3_2_8_2","first-page":"1310","article-title":"Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? t-PA\u2013the best current option for most patients.","volume":"337","author":"Grotta J","year":"1997","unstructured":"Grotta J Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? t-PA\u2013the best current option for most patients. N Engl J Med. 1997;337:1310\u20131313.","journal-title":"N Engl J Med"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041175"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214300"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1213701"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1212793"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1411587"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414905"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1414792"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415061"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503780"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.14132649"},{"key":"e_1_3_2_19_2","volume-title":"Impact of General Anesthesia on Treatment Effect in the MR CLEAN trial; a post hoc analysis","author":"Berkhemer OA","year":"2015","unstructured":"Berkhemer OA, vandenBerg LA, Fransen PSS, Beumer D, Lingsma HF, vanZwam WH, et al.. Impact of General Anesthesia on Treatment Effect in the MR CLEAN trial; a post hoc analysis. 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