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Future acute ischemic stroke trials should randomize on the angio table
  1. Mahesh V Jayaraman1,
  2. Ryan A McTaggart2,3
  1. 1Departments of Diagnostic Imaging and Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
  2. 2Departments of Radiology and Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA
  3. 3Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
  1. Correspondence to Mahesh V Jayaraman, Warren Alpert School of Medical at Brown University, 593 Eddy St, Room 377, Providence, RI 2903, USA; MJayaraman{at}

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Perhaps in order to move forward we need to take a lesson from the past. The only two positive randomized trials of intra-arterial therapy to date are PROACT II and MELT.1 ,2 In both of those cases, randomization occurred on the table, after angiographic confirmation of proximal vessel occlusion. Of patients in PROACT II randomized to a saline infusion, 25% had a good functional outcome (modified Rankin Scale 0–2) at 90 days, compared with 40% of those who received a urokinase infusion. Similarly, in MELT, 23% randomized to saline infusion had modified Rankin Scale 0–1 at 90 days compared with 42% of those with urokinase infusion. …

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  • Contributors MVJ and RAM contributed to the idea and content for this editorial.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.