Abstract
The introduction of intravenous recombinant tissue plasminogen activator (IV rt-PA) has had an impact on acute stroke therapy. However, IV rt-PA ineligible/failed patients are still at issue. The Merci retriever and Penumbra system were approved and their use is gradually spreading in Japan, but the results of randomized controlled trials were negative in terms of endovascular treatment superiority or non-inferiority to IV rt-PA or standard care. Next generation devices such as stent-like retrievers are expected to show superiority to other treatments.
On the other hand, acute surgical therapies such as the acute bypass or endarterectomy are also performed, but there are arguments concerning their usefulness and safety. Therefore, randomized trials are warranted to compare acute surgical treatments versus the best medical treatment.
