Endovascular therapy in large vessel occlusion stroke: navigating critical debates

Endovascular therapy (EVT) has transformed the acute management of large vessel occlusion strokes, with strong evidence from landmark trials validating its effectiveness. However, numerous clinical and procedural controversies remain unresolved ranging from patient selection and treatment windows to management of intracranial atherosclerotic disease and reperfusion-related injury. This editorial critically examines these debates, integrating trial data, mechanistic insights, and expert commentary. We emphasize a need for tailored approaches grounded in imaging, pathophysiology, and patient-centered outcomes. Understanding these unresolved challenges is crucial for refining EVT protocols and improving global stroke care delivery.