Proximal Intracranial Arterial Occlusions Does the Natural History Justify Further Interventional Trials?

Over the past 2 decades, the treatment of acute ischemic stroke has undergone significant changes. The National Institute of Neurological Disorders and Stroke tissue plasminogen activator study1 in 1995 followed by the third European Cooperative Acute Stroke Study (ECASS III)2 in 2008 heralded major breakthroughs in the hyperacute management of patients with ischemic stroke. Yet despite the promise of these landmark studies, the overall use of intravenous tissue plasminogen activator remained meager, reaching less than 5% of all stroke patients in the United States through 2006.3 Furthermore, for certain stroke subtypes, such as those with proximal intracranial arterial occlusions, the rate of recanalization remained low,4 resulting in poor outcomes when early recanalization was not achieved