Table 1

Randomized trials and registries of modern approaches to thrombectomy

TrialNo of patients, total/IA (when applicable)LVO locationTime window for thrombectomy, hoursStroke severity (NIHSS score)Imaging criteriaTreatment groupsmRS score=0–2 at 90 days
Randomized trials: Endovascular vs medical
MR CLEAN8 500/223ICA, M1, M2, A1, A20–6≥2No limitEndovascular arm: stent retrievers in 97% of IA cases, 87% of IA-treated patients received IV rtPA first.
Control arm: IV rtPA in 91% of patients		Endovascular group: 33%
Control group: 19%
NNT=7.1
ESCAPE13 215/165ICA, M1, both (all) M2s0–12‘Disabling’ symptoms but no strict NIHSS limitCT ASPECTS 6–10, moderate-to-good collateral status on mCTAEndovascular arm: stent retrievers in 86% of all IA cases.
73% of IA-treated patients received IV rtPA first
Control arm: IV rtPA in 79% of patients		Endovascular group: 53%
Control group: 29%
NNT=4.2
EXTEND-IA9 70/35ICA, M1, M20–6No limitCTP/MRP core <70 mLEndovascular arm: IV rtPA plus Solitaire stent retriever in all IA cases.
Control arm: IV rtPA in all		Endovascular group: 71%
NNT=3.2
SWIFT PRIME10 196/98ICA, M10–68–29CTP/MRP core ≤50 mL, CT/MRI ASPECTS 6–10Endovascular arm: IV rtPA plus Solitaire stent retriever in all IA cases.
Control arm: IV rtPA in all		Endovascular group: 60%
Control group: 35%
NNT=4
REVASCAT12 206/103Anterior circulation LVO0–8≥6CT ASPECTS 7–10, MRI DWI ASPECTS 6–10Endovascular arm: Solitaire stent retriever thrombectomy. 68% of IA-treated patients received IV rtPA first.
Control arm: IV rtPA in 78% of patients.		Endovascular group: 44%
Control group: 28%
NNT=6.3
THERAPY50 108/55ICA, M1, M2 with clot ≥8 mm in lengthNo limit but all patients received IV rtPA first≥8Exclusion: CT infarct >1/3 MCA territoryEndovascular arm: IV rtPA + aspiration with traditional penumbra separator/3D stent retriever/Solitaire/Trevo.
Control arm: IV rtPA in all.		Endovascular group: 38%
Control group: 30%
THRACE11 414/204ICA, M1, superior 1/3 of BA0–510–25No limitEndovascular arm: IV rtPA + aspiration or different brands of stent retriever devices.
Control arm: IV rtPA in all.		Endovascular group: 53%
Control group: 42%
DAWN16 206/107ICA, M16–24≥10CTP, MRP
Group A: age ≥80, core <21 mL
Group B: ag e<80, NIHSS ≥10, core <31 mL
Group C: age <80, NIHSS ≥20, core <51 mL		Endovascular arm: Trevo stent retriever
Control arm: medical management (antiplatelets)		Endovascular group: 49%
Control group: 13%
DEFUSE 315 182ICA, M16–16≥6CTP/MRP core <70 mL, Penumbra/core ≥1.8 mLEndovascular arm: direct aspiration without stent retriever in 27%, stent retrievers were used in 80% of IA interventions.
Control arm: medical management (antiplatelets)		Endovascular group: 45%
Control group: 17%
Randomized trials: comparison of endovascular approaches – aspiration vs stent retriever
ASTER51 381ICA, M1, M20–6No limitNo limitTwo endovascular arms: direct aspiration (n=192) vs primary stent retriever thrombectomy (n=182)Direct aspiration: 45%
Stent retriever: 50%
Penumbra Separator 3D52 198Any LVO ≥2.5 mm diameter0–8≥8Exclusion: CT infarct >1/3 MCA territoryTwo endovascular arms: 3D stent retriever + aspiration (n=98) vs primary aspiration (n=100)Direct aspiration: 46%
3D Stent retriever: 45%
Endovascular registries
TRACK registry18 634Any LVONo limitNo limitNo limitTrevo stent retriever in all.
51% patients received IV tPA first		Endovascular group: 48%
STRATIS registry53 984Any LVO0–88–30No limitSolitaire/Mindframe stent retriever in all.
64% patients received IV tPA first		Endovascular group: 57%
NASA registry19 354Any LVONo limitNo limitNo limitSolitaire stent retriever in allEndovascular group: 42%
STAR registry54 202ICA, M1, M20–88–30Exclusion: CT infarct >1/3 MCA territory, CT ASPECTS <7, MRI DWI ASPECTS <5Solitaire stent retriever in all.
59% patients received IV tPA first		Endovascular group: 58%

  • ASPECTS, Alberta Stroke Programme Early CT Score; BA, basilar artery; CT, computed tomography; CTA, CT angiography; CTP, CT perfusion; DWI, diffusion weighted imaging; ICA, internal carotid artery; IV, intravenous; LVO, large vessel occlusion; MCA, middle cerebral artery; MRI, magnetic resonance imaging; MRP, magnetic resonance perfusion, mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale; NNT, number needed to treat; rtPA, recombinant tissue plasminogen activator.