Endovascular Therapy for Acute Ischemic Stroke: Current Evidence and Evolving Practices.

PURPOSE OF REVIEW: This literature review highlights the recent evidence and guidelines for endovascular therapy (EVT) in patients with large-core infarctions, basilar artery occlusions, and patients presenting in the late-window.

RECENT FINDINGS: EVT provides a functional benefit for patients with large-core infarcts compared to medical management. Similar improvements have been observed in basilar artery occlusions. EVT has also demonstrated reduced disability in late-window presentations when selected by computed tomography angiogram/perfusion (CTA/CTP), or magnetic resonance imaging (MRI). New evidence suggests noncontrast CT (NCCT)-based selection may be an effective alternative. EVT can reduce disability in patients with small and large-core infarcts, basilar artery occlusions, and late-window presentations compared to medical management. To broaden patient eligibility, future research is needed to clarify EVT's efficacy in very large-core infarcts, mild severity strokes, and patients with medium vessel occlusion.