Endovascular therapy is a highly effective and safe treatment for patients with acute ischemic stroke with large vessel occlusion (LVO) and is now considered the . Complication rates of endovascular therapy are low, but its efficacy is and declines rapidly as time from symptom onset to treatment increases. Thus, it seems logical that patients with acute stroke due to LVO should get treated with endovascular therapy, if indicated, as soon as possible. At the same time, providers of this highly specialised treatment should be well-trained and meet minimum quality standards. However, in the USA, the reality of endovascular therapy is different depending on the setting: in metropolitan regions, geographically close centres capable of delivery this therapy compete with each other and struggle to find enough patients to treat, while in some rural areas access to this specialised treatment is lacking. Establishing new thrombectomy-capable stroke centres has been suggested as a solution to close this gap, but whether the quality standards of these centres would be good enough has been . To make matters worse, just as endovascular therapy centres are clustered in metropolitan areas, the same is true for primary stroke centres (ie, stroke centres that provide treatment with intravenous alteplase, but cannot provide endovascular therapy), but initial transfer of patients with LVO to primary stroke centres can lead to avoidable .

中文翻译：

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血管内治疗5年后对卒中治疗的挑战成为标准。

血管内疗法对于患有急性大血管闭塞（LVO）的急性缺血性中风患者是一种非常有效和安全的治疗方法，现在被认为是一种治疗方法。血管内治疗的并发症发生率较低，但是随着从症状发作到治疗时间的增加，其疗效是并且迅速下降。因此，如果有适应症，应尽快对因LVO引起的急性中风患者进行血管内治疗，这是合乎逻辑的。同时，这种高度专业化治疗的提供者应接受良好培训，并达到最低质量标准。但是，在美国，血管内疗法的实际情况因具体情况而异：在大都市地区，能够提供这种疗法的地理位置相近的中心相互竞争，并努力寻找足够的患者进行治疗，在某些农村地区，缺乏获得这种专门治疗的机会。有人建议建立新的具有血栓切除术能力的中风中心作为缩小这一差距的解决方案，但是这些中心的质量标准是否足够好一直是一个建议。更糟糕的是，就像血管内治疗中心聚集在大都市地区一样，主要卒中中心也是如此（即，提供静脉内阿替普酶治疗但不能提供血管内治疗的卒中中心），但最初转移LVO患者到初级中风中心可以避免。