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  • The success of mechanical thrombectomy in acute ischaemic stroke is strictly dependent on ischaemic core size and time to treatment

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Therapeutics/Prevention
Randomised controlled trials
The success of mechanical thrombectomy in acute ischaemic stroke is strictly dependent on ischaemic core size and time to treatment
  1. Fabrizio Sallustio1,
  2. Silvia Di Legge2
  1. 1Department of Neuroscience, Tor Vergata University, Rome, Italy
  2. 2Neurology Department, Centre Hospitalier Pay d'Aix, Aix-en-Provence, France
  1. Correspondence to : Dr Fabrizio Sallustio, Department of Neuroscience, Tor Vergata University, Viale Oxford 81, Rome 00133, Italy; fabriziosallustio{at}libero.it

https://doi.org/10.1136/ebmed-2015-110226

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    Commentary on: Jovin TG, Chamorro A, Cobo E, et al., REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306; Saver JL, Goyal M, Bonafe A, et al., SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95.

    Context

    Three trials showing no difference in clinical outcome between patients with acute ischaemic stroke (AIS) treated by mechanical thrombectomy (MT) and those treated by intravenous thrombolysis (IVT) had the effect of reducing the number of patients with AIS receiving endovascular therapy.1–4 Based on the enthusiasm of recent positive findings from the MR CLEAN,5 ESCAPE6 and EXTEND-IA7 trials, the REVASCAT and SWIFT PRIME trials have been stopped prematurely due to their positive findings and their results were released in April 2015. In both studies, MT was performed with the Solitaire revascularisation device, a self-expanding stent used to retrieve thrombi and restore blood flow, showing faster and higher rate of reperfusion, lower intracranial haemorrhage and better outcomes.8

    Methods

    Jovin and colleagues compared safety and efficacy of MT with medical therapy alone. The trial was conducted at four sites in …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.