- Question
- Does adding stent-retriever thrombectomy to intravenous t-PA improve 90-day functional outcome compared with t-PA alone in patients with acute ischemic stroke due to a proximal anterior intracranial circulation occlusion?
- Design
- Randomized, open-label trial (no masking of allocation) with blinded outcome assessment, conducted at 39 centers. A total of 196 patients were randomized (98 per group), and the trial was stopped early for efficacy.
- Population
- Patients with acute ischemic stroke receiving or having received intravenous t-PA, with a confirmed proximal anterior intracranial circulation occlusion and no large ischemic core, within 6 hours of symptom onset.
- Intervention
- Endovascular thrombectomy with a stent retriever (Solitaire) within 6 hours of onset, in addition to intravenous t-PA. Median time from qualifying imaging to groin puncture was 57 minutes.
- Control
- Continued intravenous t-PA alone.
- Primary outcome
- Severity of global disability at 90 days on the modified Rankin scale (0 = no symptoms, 6 = death), analyzed across the full range of scores.
- Results
- Thrombectomy reduced disability at 90 days across the entire range of the modified Rankin scale (P<0.001). Functional independence (modified Rankin 0 to 2) was higher with the intervention: 60% vs. 35% (P<0.001). Substantial reperfusion at the end of the procedure was 88%.
- Safety
- There were no significant differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12).
- Conclusion
- In patients with proximal anterior circulation occlusions treated with t-PA, stent-retriever thrombectomy within 6 hours improved 90-day functional outcomes.
- Why it matters
- Together with other contemporary trials, it supported mechanical thrombectomy as standard adjunctive therapy to t-PA in large-vessel occlusion stroke, and underscored the importance of imaging-based selection and speed of treatment.
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 15, 2026