Revascularization in acute intracranial large vessels occlusion: direct or bridging thrombectomy?

Guidelines for the early management of acute ischemic stroke recommend intravenous thrombolysis followed by endovascular treatment as the first choice for the treatment of stroke with large vessel occlusion within 4.5 h of symptom onset. However, intravenous thrombolysis before endovascular treatment is a double-edged sword, which can not only bring benefits, but also increase risks. Currently, whether it is reasonable to omit intravenous thrombolysis and directly perform endovascular treatment is one of the most controversial issue. Four randomized, controlled, multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation demonstrated that the functional independence rate of the direct endovascular treatment group is similar to that of the intravenous thrombolysis followed by endovascular treatment group, and no significant difference was observed in the incidence of symptomatic intracerebral hemorrhage and mortality between the 2 treatment groups. Direct endovascular treatment may be used as a new option for patients with acute large vessel occlusion within 4.5 h of stroke onset