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Curb your enthusiasm
  1. Felipe C Albuquerque1,
  2. Adam S Arthur2
  1. 1 Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  2. 2 Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, TN, USA
  1. Correspondence to Dr Felipe C Albuquerque, Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; felipe.albuquerque{at}

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We are in the midst of a stroke tsunami. Recent trials have established and validated mechanical thrombectomy (MT) as the standard of care for the treatment of emergent large vessel occlusion (ELVO). Never in history has more been accomplished to treat this disease that kills and maims millions. Improvements in imaging, device technology and technique have all contributed to this revolution in stroke care. However, there are good reasons at this time to call for temperance rather than exuberance. While the positive MT trials are certainly monumental for the field of neurointervention and for our patients, they have also led to several contentious issues.

The publication of the DAWN and DEFUSE three trials, which concluded that even patients outside established time frames did far better with MT than medical therapy, significantly expands the pool of patients that may benefit from endovascular treatment. The use and refinement of advanced imaging has changed the most important part of the procedure: patient selection. As in other fields, well-trained professionals confronted with a myriad of different patients must individualize treatment. Evidence-based medicine is more than a checklist and neurointerventionalists have already proven that they can offer …

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  • Contributors All authors contributed to drafting and submission of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.