INTRODUCTION: Acute ischemic stroke (AIS) is the second leading cause of death and one of the leading causes of long-term disability globally. Endovascular thrombectomy (EVT) has revolutionized treatment for large vessel occlusion (LVO), providing 20% increase in post-stroke functional independence compared to intravenous thrombolysis (IVT) alone. Despite its proven efficacy, EVT is underutilized. While it is suitable for at least 15-20% of AIS patients, its mean adoption ranges from less than 1% to 7% in different areas. AREAS COVERED: This review highlights key findings from pivotal randomized controlled trials and real-world data, focusing on patient selection criteria, advancements in thrombectomy devices, and procedural innovations. A comprehensive literature search was performed using PubMed, Scopus, EMBASE and the Cochrane Library for relevant randomized controlled trials and observational studies. EXPERT OPINION: Disparity in access to EVT requires strategic investments in healthcare systems and international multidisciplinary collaboration. Enhancing geographic coverage with thrombectomy-capable centers and optimizing prehospital triage systems are essential. Bridging the gap between treatment capability and real-world implementation is critical to improving global AIS outcomes.

Department of Cardiology 3rd Faculty of Medicine Charles University and University Hospital Královské Vinohrady Prague Czech Republic

Department of Neurology 3rd Faculty of Medicine Charles University and University Hospital Královské Vinohrady Prague Czech Republic

Department of Radiology and Nuclear Medicine 3rd Faculty of Medicine Charles University and University Hospital Královské Vinohrady Prague Czech Republic

References provided by Crossref.org