**4. Conclusion**

Gone are the days in which AIS was thought to be a terminal disease. Since The National Institutes of Neurological Disorders and Stroke rt-PA Stroke Study Group (NINDS) trial in 1995 there have been numerous advances which have prevented patients from long-term disability. Both thrombolysis and EVT are potential treatments for carefully selected patients presenting with AIS and each has its benefits as well as disadvantages. However, there still exist a major proportion of the stroke population that does not qualify for either therapy, either because they have presented out of the window or because there is no LVO. There are numerous trials underway and show promise to cover a wider population. For example, the trial TEMPO II is examining the use of thrombolysis in patients presenting with minor stroke, NIHSS<6. The TIMELESS trial is investigating the use of thrombolysis in patients presenting outside of the 4.5 hour window who would still be a candidate for EVT. Finally, better catheters and stent-retrievers are being developed to reach more distal clots without increasing complications. There are also trials underway investigating methods of improving neuroprotection and reducing cell death after AIS. Nerinetide, a drug that showed promise in pre-clinical models of ischemia and reperfusion was recently investigated and humans [82]. The drug did not seem to improve functioning in those patients who had received tPA but did show a mild treatment effect in those who did not, opening doors for future possibilities for the use of neuroprotection. While stroke creates a tremendous healthcare burden across the world, the plethora of trials currently underway provide hope that this burden will continue to decrease over the next decade.
