- Question
- Does intraarterial treatment added to usual care improve functional outcome in patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion?
- Design
- Randomized trial enrolling 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone).
- Population
- Patients with a proximal anterior circulation arterial occlusion confirmed on vessel imaging and treatable intraarterially within 6 hours of symptom onset. Mean age was 65 years and 445 patients (89.0%) received intravenous alteplase before randomization.
- Intervention
- Intraarterial treatment plus usual care; retrievable stents were used in 190 of the 233 patients (81.5%) in this group.
- Control
- Usual care alone.
- Primary outcome
- Modified Rankin scale score at 90 days (0 = no symptoms, 6 = death), analyzed as an ordinal shift using an adjusted common odds ratio.
- Results
- The adjusted common odds ratio was 1.67 (95% CI, 1.21 to 2.30) favoring intraarterial treatment. Functional independence (modified Rankin score 0 to 2) was 32.6% vs. 19.1%, an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2).
- Safety
- There were no significant differences in mortality or symptomatic intracerebral hemorrhage.
- Conclusion
- In patients with acute ischemic stroke due to a proximal intracranial anterior circulation occlusion, intraarterial treatment within 6 hours was effective and safe.
- Why it matters
- It provided the first robust proof of functional benefit of mechanical thrombectomy in acute ischemic stroke and laid the groundwork for its adoption as standard care for proximal occlusions.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026