Table 1

Characteristics of included trials

CharacteristicDIRECT-MT18 DEVT12 SKIP17 MR CLEAN-NO IV19
TreatmentEVT (n=327)/IVT before EVT (n=329)EVT (n=116)/IVT before EVT (n=118)EVT (n=101)/IVT before EVT (n=103)EVT (n=273)/IVT before EVT (n=266)
Inclusion criteriaAge ≥18 years, mRS of 0 or 2 before onset
ICA, MCA-M1, or M2 occlusion on CTA
ASPECTS: no limit
Onset to IV rt-PA ≤4 hours 30 min
Age ≥18 years, mRS of 0 or 1 before onset
ICA or MCA-M1 occlusion on CTA or MRA
NIHSS: no limit
ASPECTS: no limit
Onset to randomization ≤4 hours 15 min
Age ≥18 and <86 years, mRS of 0 or 2 before onset
ICA or MCA-M1 occlusion on CTA or MRA
ASPECTS: DWI ≥5 or CT ≥6
Onset to puncture <4 hours
Age ≥18 years, mRS of 0 or 2 before onset
ICA or MCA-M1 or proximal M2 occlusion on CTA or MRA
ASPECTS: no limit
CountryChinaChinaJapanEuropean countries
Age (years)69 (61–76)/69 (61–76)70 (60–77)/70 (60–78)74 (67–80)/76 (67–80)72 (62–80)/69 (61–77)
Male189 (58%)/181 (55%)66 (57%)/66 (56%)56 (55%)/72 (70%)161 (59%)/144 (54%)
ASPECT9 (7–10)/9 (7–10)8 (7–9)/8 (7–9)7 (6–9)/8 (6–9)NA/NA
Alteplase dose (mg/kg)
Medical history
 Hypertension193 (59%)/201 (61%)69 (59%)/74 (62%)61 (60%)/61 (59%)NA/NA
 AF152 (46%)/149 (45%)62 (53%)/62 (52%)57 (56%)/64 (62%)86 (32%)/63 (24%)
 Smoking73 (22%)/68 (20%)28 (24%)/29 (24%)42 (42%)/54 (52%)NA/NA
 Dyslipidemia13 (4%)/14 (4%)18 (15%)/22 (18%)30 (30%)/37 (36%)NA/NA
 DM59 (18%)/65 (19%)25 (21%)/20 (17%)16 (16%)/17 (17%)NA/NA
 Past stroke43 (13%)/47 (14%)14 (12%)/19 (16%)12 (12%)/14 (14%)NA/NA
 Embolic146 (44%)/144 (43%)65 (56%)/69 (58%)67 (66%)/72 (15%)NA/NA
 Atherosclerosis26 (8%)/19 (5%)*28 (24%)/23 (19%)*21 (21%)/15 (15%)†NA/NA
Occlusion site
 ICA112 (35%)/114 (35%)18 (15%)/17 (14%)41 (41%)/36 (35%)68 (25%)/50 (19%)
 M1 proximal161 (50%)/178 (54%)95 (81%)/99 (83%)19 (19%)/18 (17%)156 (57%)/174 (65%)
Median duration (min)
 Onset to randomization167/177170/168129/13694/93
 IVT to punctureNA/26NA/40NA/8NA/NA
 Onset to puncture198/213200/210149/158130/135
sICH definitionHeidelberg Bleeding Classification‡SITS-MOST§SITS-MOST§Heidelberg Bleeding Classification‡
  • Trial name: DIRECT-MT: Thrombectomy in Order to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: a Multicenter Randomized Clinical Trial; DEVT: Direct Endovascular Thrombectomy vs Combined IVT and Endovascular Thrombectomy for Patients With Acute Large Vessel Occlusion in the Anterior Circulation; SKIP: The Direct Mechanical Thrombectomy in Acute LVO Stroke; MR CLEAN-NO IV: The Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) NO IV study group.

  • *Intracranial atherosclerosis.

  • †Large artery atherosclerosis.

  • ‡The Heidelberg Bleeding Classification: new intracranial hemorrhage detected by brain imaging associated with any of the item below: ≥4 points total NIHSS at the time of diagnosis compared with immediately before worsening. ≥2 points in one NIHSS category. The rationale for this is to capture new hemorrhages that produce new neurological symptoms, making them clearly symptomatic but not causing worsening in the original stroke territory. For example, a new remote hemorrhage in the contralateral occipital lobe may cause new hemianopia that is clearly symptomatic but the patient will not have worsening of ≥4 points on the NIHSS score.

  • §SITS-MOST: a large local or remote parenchymal intracranial hemorrhage (>30% of the infarcted area affected by hemorrhage with a mass effect or extension outside the infarct) in combination with neurologic deterioration from baseline (increase of 4 in the NIHSS score) or death within 36 hours.

  • AF, atrial fibrillation; ASPECT, Alberta Stroke Program Early CT score; CT, computed tomography; CTA, CT angiography; DM, diabetes mellitus; DWI, diffusion weighted imaging; EVT, endovascular thrombectomy; ICA, internal carotid artery; IV, intravenous; IVT, intravenous thrombolysis; MCA, middle cerebral artery; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; mRS, modified Rankin Scale; NA, not available; NIHSS, National Institutes of Health Stroke Scale; rt-PA, recombinant tissue plasminogen activator; sICH, symptomatic intracranial hemorrhage.