In the past 5 years, the success of multiple randomized controlled trials of recanalization therapy with endovascular thrombectomy has transformed the treatment of acute ischemic stroke with large vessel occlusion. The evidence from these trials has now established endovascular thrombectomy as standard of care. This review will discuss the chronological evolution of large vessel occlusion treatment from early medical therapy with tissue plasminogen activator to the latest mechanical thrombectomy. Additionally, it will highlight the potential areas in endovascular thrombectomy for acute ischemic stroke open to exploration and further progress in the next decade.
Keywords: Acute ischemic stroke (AIS); Clinical imaging mismatch; Endovascular thrombectomy (EVT); Ischemic penumbra; Perfusion mismatch; Symptomatic intracerebral hemorrhage (sICH); Therapeutic time window.