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  1. Italo Linfante
  1. Correspondence to Dr Italo Linfante, Miami Cardiac and Vascular Institute, Baptist Hospital and Neuroscience Center, 8900 North Kendal Drive, Miami, FL 33176, USA; linfante.italo{at}gmail.com

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“Salimmo sù, el primo e io secondo,tanto ch'i’ vidi de le cose belleche porta ‘l ciel, per un pertugio tondo.E quindi uscimmo a riveder le stelle.”“We mounted up, he first and I the second,Till I beheld through a round apertureSome of the beauteous things that Heaven doth bear;Thence we came forth to rebehold the stars.”Inferno, Canto 34, 138.Dante Alighieri (Firenze 1265- Ravenna 1321)

In 2015 the stroke world was awoken by the proof of the validity of endovascular thrombectomy (ET) as a treatment of cerebral ischemia secondary to emergent large vessel occlusion (ELVO). Presently, even the most recalcitrant skeptics cannot possibly deny the level 1A evidence produced by five controlled randomized clinical trials showing superiority of ET over medical management.1–5 Remarkably, these trials were conducted in different parts of the world by different operators and yet showed very similar rates of recanalization and clinical outcomes. The validity and reproducibility of these trials was the result of a combination of excellent trial design, patient population selection, as well as fast and high rates of recanalization of the occluded artery.

As we celebrate this monumental advancement in the treatment of ischemic stroke, we must look forward to find ways to obtain even better outcomes. In these trials, despite high rates of Thrombolysis In Cerebral Infarction (TICI) grade >2b recanalization, good outcome (assessed by modified Rankin Scale (mRS) score ≤2 at 90 days) was achieved in 33–71% of patients.1–5 Clearly, short time from symptom onset to recanalization, selection of patients with small ischemic core volume, and good collateral circulation improve the odds of a good clinical outcome. Technological advancements in devices are already taking place. The aim is to improve recanalization rates with a target of TICI 3, first pass …

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