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Emergent large vessel occlusion (ELVO) is a ’hot topic' for neuroInterventionalists (NI) in 2018.1 In 1996, the US Food and Drug Administration (FDA) approved the use of IV rtPA for the treatment of acute ischemic stroke within three hours of symptom onset.2 Intra-arterial prourokinase was studied in the PROACT trials but was not approved for use based, in part, on concerns that related to hemorrhagic complications present in the treatment arm of PROACT II.3 4 This disappointment in chemical thrombolysis pushed mechanical thrombectomy (MT) forward.
In 2004, the FDA approved the flexible, looped nitinol wire called MERCI for the indication of intracranial clot retrieval in patients with acute ischemic stroke.5 6 Penumbra originally employed two different treatment options: a reperfusion catheter and separator device; and direct thrombus extraction with a ring retriever while a balloon-guide catheter was used to temporarily arrest flow.7 The Penumbra Pivotal trial that exclusively utilized the first approach described above resulted …
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.