Ischemic stroke is associated with an enormous burden of neurological morbidity and mortality.1 Cardioembolic and atherothrombotic stroke subtypes of Ischemic stroke have demonstrated the highest mortality.2 For the last few decades, the standard treatment for ischemic strokes has been intravenous alteplase (IVA) within the boundary of the recommended 4.5-hour window.

However, the narrow time window and the low recanalization rates in patients with large vessel occlusion and bleeding complications have reduced the efficacy of this treatment modality in Acute Ischemic Stroke (AIS) with large vessel occlusion (LVO). Reported recanalization rates for middle cerebral artery occlusions are approximately 35 %, while for carotid artery occlusions, the rates are around 6 %, often associated with poor clinical outcomes.3

Evidence-based outcomes from the recent literature and five randomized controlled trials in 2015 have revealed the significant usefulness and benefit of Endovascular treatment (EVT) in the management of large vessel occlusion, especially middle cerebral artery, hailing it as an efficacious standardized treatment for ischemic stroke management compared to IVA. However, a shadow of uncertainty still exists about EVT regarding different age groups, patients having mild deficits, or ineligibility for Intravenous alteplase.4 EVT includes catheter-dependent therapies such as angioplasty with stenting, thromboembolectomy, suction thrombectomy, and stent retriever thrombectomy. These catheter-based therapies are usually used in conjunction with either IVA or intra-arterial thrombolysis (IAA), with promising clinical outcomes.5

Endovascular devices such as retrievable stents navigate vessel recanalization through thrombus-retrieval mechanical thrombectomy. This mechanism restores early blood flow without the risk of complications such as thrombosis or in-stent restenosis.6 However, due to specialized procedural requirements, EVT use is limited by the availability of a dedicated team at all centers. In addition, its use is also associated with a higher incidence of intracranial hemorrhage.7

EVT has been studied in multiple clinical trials. However, studies assessing the clinical outcomes in national inpatient samples are limited. Our study aims to unravel the important clinical outcomes and assess their utility in the current dynamics.