From Thrombolysis, to Thrombectomy in Acute Ischemic Stroke

(1) Background: Until the early 1990s, ischemic stroke (IS) was considered a sinister fatality due to a lack of effective recanalization therapy allowing a prompt reperfusion of the ischemic brain, a key factor in reducing neurological disability. (2) Method: Over the past 30 years, the ischemic penumbra has gradually become the target of new reperfusion strategies to reduce ischemic stroke-related neurological disability. Ischemic stroke therapy has benefited from three major advances that upset its management: (1) The benefit of intravenous thrombolysis by Tissue Plasminogen Activator rt-PA. (2) The success of endovascular treatment for large arteries occlusion. (3) The development of stroke imaging. The “time is brain” aphorism anchored IS in the emergency field, which led to rapid transfers to stroke units. (3) Results: We propose to report the main stages of this therapeutic transformation in this major area of public health. (4) Conclusion: Although access to these transformations remains limited in the world and much remains to be done to improve the IS care system, this area has experienced an unprecedented upheaval in the history of neurology.