Emerging strategies to improve outcomes following endovascular thrombectomy

Background: Endovascular thrombectomy is the standard treatment for acute ischemic stroke caused by large vessel occlusion. In randomized trials, about half of treated patients do not regain functional independence at 90 days, including patients with successful reperfusion. Objective: To review the factors associated with limited recovery after thrombectomy and the strategies that have been tested to improve outcomes. Methods: We searched PubMed and Google Scholar through July 2026 for relevant randomized controlled trials and meta-analyses in seven areas: blood pressure management after the procedure, bridging thrombolysis and tenecteplase, neuroprotection, intra-arterial adjuncts, device technique and reperfusion quality, glycemic and metabolic management, and rehabilitation. Conclusions: The treatment gap between successful recanalization and functional recovery is still one of the major challenges in thrombectomy care. Existing data across blood pressure management, sequential or concurrent thrombolytic treatments, neuroprotection, intra-arterial adjuncts, and rehabilitation is evolving, but no single adjuvant strategy has yet been proven as standard care.