| Anterior Circulation MT | |
|---|---|
| (MR CLEAN) A randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke _____ RCT comparing usual stroke care to usual care + mechanical thrombectomy for proximal anterior cerebral large artery occlusions within 6 hours of LKW, finding significantly improved functional outcome in the thrombectomy group. | LINK |
| (EXTEND-IA) Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection _____ RCT in patients with large vessel occlusion of the anterior circulation who received alteplase within 4.5 hours of stroke, comparing thrombectomy using solitaire device within 6 hours to medical therapy alone. Perfusion imaging was used to select for ischemic core <70 cc and salvageable tissue. The thrombectomy group had greater rates of reperfusion, early neurologic improvement, and functional independence. | LINK |
| (DEFUSE 3) Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging _____ RCT comparing thrombectomy at 6-16 hours from LKW to medical therapy alone in patients with anterior circulation LVO and perfusion imaging with <70 cc core infarct and ratio of ischemic tissue >1.7, finding improved functional outcomes and mortality at 90 days in the interventional group. | LINK |
| (DAWN) Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct _____ RCT comparing thrombectomy to medical care alone in patients with anterior circulation LVO and LKW of 6-24 hours, selected by perfusion imaging criteria adjusted by age more or less than 80. Superior functional outcomes at 90 days were noted in the interventional group. | LINK |
| (DIRECT-MT) Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke _____ RCT in patients with anterior circulation LVO who qualify for mechanical thrombectomy and alteplase, comparing mechanical thrombectomy alone to thrombectomy preceded by alteplase within 4.5 hours. Thrombectomy alone was found to be non-inferior to combined alteplase + thrombectomy, but with lower rates of pre-interventional and overall recanalization. | LINK |
| Posterior Circulation MT | |
|---|---|
| (ATTENTION) Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion _____ RCT in patients with basilar occlusion within 12 hours of LKW comparing mechanical thrombectomy to medical care alone, finding better functional outcomes in the interventional group, but with increased rates of ICH and procedural complications. | LINK |
| (BAOCHE) Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion _____ RCT in patients with basilar occlusion 6-24 hours after LKW comparing mechanical thrombectomy to medical care alone, finding improved 90-day functional status in the interventional group, but with some increase in ICH incidence (Note: Primary outcome was changed from mRS 0-4 to mRS 0-3 during the trial. No significant difference in the original primary outcome was seen between groups) | LINK |
| Large Core MT | |
|---|---|
| (RESCUE-Japan LIMIT) Endovascular Therapy for Acute Stroke with a Large Ischemic Region _____ A Japanese multicenter RCT assigning adults with ICA or M1 occlusion, NIHSS≥6, baseline mRS≤1, and ASPECTS 3-5 by CT or MRI within 6 hours, or 6-24 hours if no FLAIR change on initial MRI, to endovascular therapy or medical management alone, with primary outcome of 90-day mRS 0-3. Significantly greater odds of good functional status were seen in the interventional group with a generally favorable shift of mRS scores toward intervention. The endovascular group experienced more frequent ICH. | LINK |
| (ANGEL-ASPECT) Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct _____ A Chinese multicenter RCT evaluating patients within 24h of LKW with ICA or M1 occlusion, NIHSS 6-30, mRS≤1, and CT ASPECTS 3-5 or infarct core 70-100 cc (if ASPECTS 0-2, or >5 at 6-16 hours). Patients were assigned to endovascular therapy vs medical management alone. There was a significant shift in 90-day mRS in favor of endovascular therapy, as well as greater odds of achieving mRS 0-2 or 0-3. The endovascular group experienced more frequent ICH. | LINK |
| (SELECT-2) Trial of Endovascular Thrombectomy for Large Ischemic Strokes _____ An international RCT assigning patients with ICA or M1 occlusion, mRS≤1, and CT ASPECTS 3-5 or core infarct size ≥50 cc based on CTP or MRI to endovascular therapy within 24h or medical management alone, with primary outcome of 90-day mRS. There was a significant shift in 90-day mRS favoring endovascular therapy, as well as significantly increased odds of functional independence and independent ambulation without a significant difference in symptomatic ICH. | LINK |