Endovascular treatment for the acute ischemic stroke: the past and the future

Occlusion of large arteries, such as terminal parts of internal carotid artery (ICA) and main stem of middle cerebral artery (MCA), often result in poor outcomes of the acute ischemic stroke (AIS) patients. Recently, randomized controlled trials (RCTs) have consistently confirmed the benefit of endovascular treatment in AIS patients. With the positive results of these studies, endovascular recanalization therapy has been recommended as standard stroke care by stroke guidelines. In this review, we describe the strategies of endovascular treatment, analyze the reasons of the superiority of the thrombectomy in recent trails. The therapeutic time window, better patient selection, expediting and enhancing recanalization, and the addition of neuroprotective agents are the important factors we should focus on in the future.