Skipping Intravenous Thrombolysis Before Endovascular Thrombectomy May Be an Option

Previous pivotal trials evaluating endovascular thrombectomy for large-vessel ischemic stroke allowed eligible patients to receive standard-of-care intravenous thrombolysis within 4.5 hours of last seen well, given the ethical considerations of withholding a proven treatment (thrombolysis) when assessing an investigational one (thrombectomy). Now that the benefits of mechanical thrombectomy are well established, clinicians have revisited the notion that intravenous thrombolysis, which achieves recanalization for large-vessel occlusion less than half of the time, may be superfluous when very high recanalization rates can be achieved with endovascular thrombectomy alone. Two recently published randomized trials directly addressed this clinica…