Stroke Trials

  • MR CLEAN- January 2015

    • 500 patients, 18 years +, NIHSS >2, symptom onset <6 hours, proximal occlusion on CTA, ASPECTS 7-10

    • mRS 0-2 33% endovascular vs 19% control

  • ESCAPE- February 2015

    • 315 patients, NIHSS >12, ASPECTS >5, symptom onset <12 hours, proximal occlusion on CTA + perfusion

    • mRS 0-2 53% endovascular vs 29% control

    • Mortality 10% endovascular vs 19% control

    • Trial demonstrated short imaging to reperfusion time improves chances of functional independence

  • Extend-IA- February 2015

    • 70 patients, no age, no NIHSS, symptoms <4.5 hours

    • mRS 0-2 71% endovascular vs 40% control

    • Mortality 9% endovascular vs 20% control

  • SWIFT PRIME- February 2015

    • 196 patients, 18-80, NIHSS 8-29, ASPECTS >6, CTA or MRA

    • mRS 0-2 60% endovascular vs 36% control

    • No significant change in symptomatic ICH (sICH)

  • REVASCAT- February 2015

    • 206 patients, 18-80, NIHSS >6, symptoms <8 hours, ASPECTS >7, CTA

    • mRS 0-2 44% endovascular vs 28% control

    • Contributed to evidence support thrombectomy up to 8 hours

  • DAWN- January 2018

    • 206 patients, 6-18 hours symptom onset, CTP or MR diffusion

    • NIHSS >10 if >80 age

    • NIHSS >10, core volume <31mL OR NIHSS >20 core volume <51mL if <80

    • 2 point difference in 90 day mRS. 73% relative reduction of dependency of SDLs

    • 35% absolute increase in number of patients achieving functional independence

    • This trial expanded population who can benefit from thrombectomy

    • Patient treated earlier had better outcomes, but eligibility should not be restricted by time window

  • DEFUSE 3- January 2018

    • 182 ptients, 6-16 hours symptom onset, RAPID used for all

    • Core <70 mL if >80, Mismatch ratio greater than or equal to 1.8 or mismatch volume greater than or equal to 15 if <80

    • More favorable mRS

    • mortality 14% endovascular vs 26% medical therapy

 

Recommendations

  •  Endovascular treatment 0-6 hours after symptom onset should receive endovascular therapy if:

    • Prestroke mRS 0-1

    • LVO present

    • Age >18

    • NIHSS greater than or equal to 6

    • ASPECTS greater than or equal to 6

    • Treatment can be initiated within 6 hours of symptom onset

  • Endovascular treatment 6-24 hours after onset should receive endovascular therapy if:

    • Selected patients 6-16 hours after LKN with anterior circulation LVO and meet DAWN or DEFUSE 3 criteria

    • Selected patients 16-24 hours after LKN with anterior circulation LVO and meet DAWN criteria