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Linger et al. Vessel Plus 2020;4:36 I http://dx.doi.org/10.20517/2574-1209.2020.51 Page 7 of 9

suite, bypassing both the emergency department and conventional CT scanner [54,55] . A flat panel CT using
angiography equipment (or in some cases a separate CT scanner in the angio-suite) can be used to exclude
intracerebral hemorrhage, followed by diagnostic angiography and treatment if a LVO is detected. In one
observational study, this resulted in significantly shorter median door-to-arterial access times (16 min
vs. 70 min; P < 0.01) and greater functional independence at 90 days (defined as mRS 0-2; 41 vs. 28%; P
[55]
= 0.05) . However, whether this is an efficient use of limited angiography suite resources remains to be
determined.

CONCLUSIONS AND FUTURE DIRECTIONS
Effective and rapid reperfusion remains the only proven approach to reduce disability in ischemic stroke
patients. Thrombectomy has been a major advance, and the indications continue to broaden. Device
evolution is likely to continue and the emphasis for technical procedural success is now on rapid “first
[56]
pass” near-complete reperfusion . Mild stroke, distal occlusion and patients with large ischemic core are
the current frontiers on which randomized trials are focused. Neuroprotection may yet prove beneficial
with a recent trial of nerinetide being neutral overall but suggesting benefit in patients who did not receive
[57]
thrombolysis . Systems of care innovations to accelerate treatment are highly achievable and of critical
importance to continue to reduce the disability associated with LVO ischemic stroke.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the commentary and performed data
interpretation: Linger M, Campbell BCV

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
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2. Campbell BC, Mitchell PJ, Kleinig TJ, et al; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-
imaging selection. N Engl J Med 2015;372:1009-18.
3. Goyal M, Demchuk AM, Menon BK, et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of
ischemic stroke. N Engl J Med 2015;372:1019-30.
4. Saver JL, Goyal M, Bonafe A, et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in
stroke. N Engl J Med 2015;372:2285-95.