Following the successful completion of 5 major trials establishing the clinical efficacy of endovascular
thrombectomy for ELVO in the setting of AIS, there has been a tremendous focus on identifying additional patient populations that may benefit from the intervention. Improved imaging modalities and subsequent trials found
thrombectomy to be highly efficacious in patients presenting up to 24 hours after
stroke onset, particularly with good collaterals and large penumbral regions. Iterative
catheter and device development have improved the safety profile and enhanced the efficacy of the procedure with the introduction of balloon-guide
catheters, larger bore navigable aspiration
catheters, and smaller
catheters and devices to access medium and distal vessel occlusions. While trials are ongoing to assess the utility of
thrombectomy in patients presenting with large core
infarcts, distal occlusions, and direct aspiration as a first-line approach, the highly effective nature of
thrombectomy for ELVO is continuing to drive the field of endovascular
stroke care forward.