The Challenges of Microvascular Disease in the Era of Endovascular Thrombectomy

We are facing and extremely exciting era after knowing the results of the recently finished clinical trials on the effectiveness of endovascular thrombectomy in acute stroke patients with large vessel occlusion [13]. The MRCLEAN, ESCAPE, EXTEND-IA and SWIFT-PRIME trials showed that a significant proportion of patients with acute stroke may greatly benefit from endovascular thrombectomy with the current generation of stentriever devices and these results are expected to be confirmed by the REVASCAT trial [4] to be presented in the upcoming European Stroke Organization Conference in Glasgow next April. One of the most interesting aspects of these studies is that patients with poor prognostic factors such as advanced age or tandem occlusions also benefit from endovascular thrombectomy, because their functional outcome is terrible when only medical therapy is used.