Table 3

GRADE evidence profile for PICO 1

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	MT alone	IVT+	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Good outcome (mRS 0–2 at 90 days) – OR, unadjusted analysis
6	Randomized trials	Not serious	Serious*	Not serious	Not serious	None	570/1162 (49.1%)	595/1169 (50.9%)	OR 0.93 (0.79 to 1.10)	18 fewer per 1000 (from 59 fewer to 24 more)	⨁⨁⨁◯ Moderate	CRITICAL
Good outcome (mRS 0–2 at 90 days) – RR, unadjusted analysis
6	Randomized trials	Not serious	Serious*	Not serious	Not serious	None	570/1162 (49.1%)	595/1169 (50.9%)	RR 0.96 (0.89 to 1.04)	20 fewer per 1000 (from 56 fewer to 20 more)	⨁⨁⨁◯ Moderate	CRITICAL
Reduced disability (≥1 point reduction across all mRS scores at 90 days) – cOR, adjusted analysis
6	Randomized trials	Not serious	Serious*	Not serious	Not serious	None			cOR 0.92 (0.80 to 1.07)	1 fewer per 1000 (from 1 fewer to 1 fewer)	⨁⨁⨁◯ Moderate	CRITICAL
Excellent outcome (mRS 0–1 at 90 days) – OR, unadjusted analysis
6	Randomized trials	Not serious	Serious*	Not serious	Not serious	None		358/1169 (30.6%)	OR 0.99 (0.82 to 1.18)	2 fewer per 1000 (from 40 fewer to 36 more)	⨁⨁⨁◯ Moderate	CRITICAL
All-cause mortality at 90 days – OR, unadjusted analysis
6	Randomized trials	Not serious	Not serious	Not serious	Not serious	None	186/1163 (16.0%)	175/1169 (15.0%)	OR 1.06 (0.84 to 1.35)	8 more per 1000 (from 21 fewer to 42 more)	⨁⨁⨁⨁ High	CRITICAL
Successful reperfusion (mTICI ≥2 b) at the end of the endovascular procedure
6	Randomized trials	Not serious	Not serious	Not serious	Not serious	None	935/1108 (84.4%)	990/1125 (88.0%)	OR 0.72 (0.57 to 0.92)	39 fewer per 1000 (from 73 fewer to 9 fewer)	⨁⨁⨁⨁ High	IMPORTANT
Symptomatic intracranial hemorrhage
6	Randomized trials	Not serious	Serious†	Not serious	Not serious	None	50/1163 (4.3%)	67/1166 (5.7%)	OR 0.77 (0.52 to 1.13)	13 fewer per 1000 (from 27 fewer to 7 more)	⨁⨁⨁◯ Moderate	CRITICAL
Any intracranial hemorrhage
6	Randomized trials	Not serious	Not serious	Not serious	Not serious	None	361/1138 (31.7%)	415/1140 (36.4%)	OR 0.80 (0.66 to 0.96)	50 fewer per 1000 (from 90 fewer to 9 fewer)	⨁⨁⨁⨁ High	IMPORTANT

*According to each trial’s criteria, non-inferiority was met in DIRECT-MT and DEVT, whereas this was not the case for all other trials.
†Definitions of symptomatic intracranial hemorrhage varied across studies.
cOR, common OR; GRADE, Grading of Recommendations, Assessment, Development and Evaluations ; IVT, intravenous thrombolysis with alteplase; mRS, modified Rankin Scale; MT, mechanical thrombectomy; mTICI, modified Treatment In Cerebral Ischemia; PICO, Population, Intervention, Comparator, Outcome; RR, risk ratio.