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Reflections on the lessons of the recent endovascular stroke trials
  1. Rishi Gupta1,2
  1. 1Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Neurosurgery, Wellstar Medical Group, Marietta, Georgia, USA
  1. Correspondence to Dr Rishi Gupta, Emory University School of Medicine, 80 Jesse Hill Jr Drive, SE, Faculty Office Building #393, Atlanta, GA 30303, USA; rishi.gupta{at}

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Science is simply common sense at its best, that is, rigidly accurate in observation, and merciless to fallacy in logic. Thomas Henry Huxley

As the stroke community is invigorated by the recent results of the four trials showing the overwhelming efficacy of endovascular therapy for large vessel occlusion,1–4 we should reflect upon lessons that were learned that may help future clinical initiatives. It has been almost 16 years since the PROACT-II trial showed a 15% absolute difference in outcomes in patients treated with intra-arterial pro-urokinase for a middle cerebral artery (MCA) occlusion compared with medical therapy.5 Although the trial did not compare an endovascular approach with intravenous tissue plasminogen activator (t-PA), we must acknowledge that the journey from the presentation of PROACT-II (ironically at the International Stroke Conference in 1999 in Nashville also) to today has been arduous and protracted.

I would like to share a story of a patient I treated last year, prior to the recent data. A patient of roughly the …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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