Complete and rapid revascularization can dramatically reduce disability after large-vessel occlusion (LVO) acute ischemic stroke (AIS).1 With modern mechanical thrombectomy (MT), we now have a safe and effective method to recanalize occluded cerebral vessels, and in this issue of JAMA Neurology, Kaesmacher et al2 move the field 1 step closer to achieving the goal of complete revascularization. Cohort studies have demonstrated that even among patients who achieve substantial reperfusion, defined as a Thrombolysis in Cerebral Infarction grade of 2b or greater, those who achieve the highest grades of reperfusion have quantifiably improved outcomes, but only a minority are able to achieve these highest grades.3 As such, one of the primary targets for improvement in MT is finding reliable means of achieving near-perfect reperfusion.
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Lopez-Rivera V, Sheth SA. Potential of Intra-arterial Urokinase After Incomplete Mechanical Thrombectomy—Looking Back, Moving Forward. JAMA Neurol. 2020;77(3):298–299. doi:10.1001/jamaneurol.2019.3984
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