Endovascular therapy in large vessel occlusion stroke: navigating critical debates

Vishal Chavda; Harisinh Parmar; Creed M Stary; Raxit Bhrambhatt; Stefano M Priola; Giuseppe Emmanuele Umana; Kodeeswaran M; Luis Rafel Moscote Salazar; Bipin Chaurasia

doi:10.1097/MS9.0000000000003532

Endovascular therapy in large vessel occlusion stroke: navigating critical debates

Ann Med Surg (Lond). 2025 Jul 16;87(8):4721-4723. doi: 10.1097/MS9.0000000000003532. eCollection 2025 Aug.

Authors

Vishal Chavda¹, Harisinh Parmar², Creed M Stary³, Raxit Bhrambhatt¹, Stefano M Priola⁴, Giuseppe Emmanuele Umana^{5

6}, Kodeeswaran M⁷, Luis Rafel Moscote Salazar⁸, Bipin Chaurasia⁹

Affiliations

¹ Department of Medicine and Critical Care, Multispecialty, Trauma and ICCU Centre, Sardar Hospital, Ahmadabad, Gujarat, India.
² Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
³ Department of Anaesthesia and Perioperative Pain Medicine, Stanford School of Medicine, Stanford University Medical Centre, Stanford, CA, USA.
⁴ Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON, Canada.
⁵ Department of Neurosurgery, Trauma and Gamma-Knife Center, Cannizzaro Hospital, Catania, Italy.
⁶ Department of Medicine and Surgery, Kore University of Enna, Enna, Italy.
⁷ Department of Neurosurgery, Kilpauk Medical College, Chennai, India.
⁸ Department of Clinical Research, AV Healthcare Innovators, LLC, Madison, WI, USA.
⁹ Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal.

Abstract

Endovascular therapy (EVT) has transformed the acute management of large vessel occlusion strokes, with strong evidence from landmark trials validating its effectiveness. However, numerous clinical and procedural controversies remain unresolved ranging from patient selection and treatment windows to management of intracranial atherosclerotic disease and reperfusion-related injury. This editorial critically examines these debates, integrating trial data, mechanistic insights, and expert commentary. We emphasize a need for tailored approaches grounded in imaging, pathophysiology, and patient-centered outcomes. Understanding these unresolved challenges is crucial for refining EVT protocols and improving global stroke care delivery.

Keywords: endovascular therapy; intracranial atherosclerotic disease (ICAD); ischemic stroke; large vessel occlusion stroke (LVOS); mechanical thrombectomy; reperfusion injury; stroke management.

Publication types

Editorial