Following the road of progress in acute ischemic stroke care

fter decades of delay, if compared to other medical emergencies like myocardial infarction, knowledge about stroke finally achieved a grade that allows interven-tion to change its natural history. That has been a long road. The acute stroke phase comprises the first few hours, when the potential max-imal lesion is not necessarily established yet, creating a time window for intervention.The use of the intravenous rt-PA is the standard treatment for acute ischemic stroke, with evidence of its benefits for eligible patients. One of the advantages of this approach is the pos-sibility of intervening soon after the patient was assessed. Despite this advantage, only a small proportion of patients benefit from intravenous t-PA, mainly due to its short therapeutic win-dow (≤ 4.5 hours) and poor performance in large vessel occlusion. Intra-arterial thrombolysis via catheter (IAT) has been performed for more than 30 years, as an alternative or as a adjunctive treatment, but its exact role was not clear until recently, despite teams involved had a positive impression about results, at least in part of patients. New devices were developed to extract the thrombus without or after pharmacological intervention, but the evidence of its benefit remained lacking. In 2013 three negative trials put IAT in great doubt