Reimbursement for Thrombectomy Devices in Patients Who Are Ineligible for Intravenous Tissue-Type Plasminogen Activator

Intravenous tissue-type plasminogen activator (t-PA) is an effective treatment for acute ischemic stroke for which efficacy is very time dependent and its greatest benefit occurs with early treatment.1 Not all patients with ischemic stroke who arrive within 2 to 3 hours after stroke onset are eligible for IV t-PA because they have contraindications, such as recent major surgery, ongoing anticoagulation at the time of stroke, etc.2 These t-PA–ineligible patients with moderate and severe strokes are often treated with intra-arterial t-PA via an endovascular procedure and, more recently, thrombectomy devices. Moreover, a sizable proportion of patients with moderate to severe stroke who do receive IV t-PA still have a poor outcome because IV t-PA was unable to lyse the clot or did so after the brain was irreversibly destined for infarction.1,3 Thus, there is a great need for more rapid and effective approaches to reperfusion.The Interventional Management of Stroke (IMS) III trial, a National Institute of Neurological Disorders and Stroke–funded study recently published in NEJM , …