Endovascular Thrombectomy and Stroke Physicians: Equity, Access, and Standards.

See related articles, p 2310, 2313, 2318 In medicine, we are traditionally wary about using the term breakthrough, much loved by the media. However, the dramatic benefits of endovascular thrombectomy actually justify the use of this term. Based on the landmark clinical trials, only 2.6 patients need to be treated to improve functional outcome, and in expert hands, the intervention is remarkably safe.1 The challenge is enormous, given that ≈11% patients with ischemic stroke have large artery occlusion.2 This is now even more pressing, given that the time window for intervention is likely to be substantially extended in patients selected with advanced imaging, with small ischemic cores and salvageable tissue.3 Within months of the evidence becoming available from the landmark trials in 2015, new treatment guidelines were published.4–6 At the clinical coalface, we are now seeing many patients treated with large artery occlusion and moderate to severe neurological deficits, who can actually be discharged home within days of their intervention. The key issues addressed in these articles7–9 relate to patients being able to speedily access this therapy, a major challenge in metropolitan, but particularly rural settings. Of crucial importance, the standards in interventional centers in terms of reperfusion rates, safety, and clinical outcomes need to mirror the trial results. Stroke treatment clearly mandates a specialized multidisciplinary team in an adequately resourced center, led by a stroke specialist. We prefer the term stroke physician rather than vascular neurologist so that an appropriately trained physician is not excluded although most stroke specialists will have a neurological training. Clearly, the stroke physician must be trained and expert in …