Among patients with proximal vessel occlusion in the anterior circulation, up to 80% die within 90 days of stroke, or do not regain functional independence despite alteplase treatment. Recent studies have demonstrated the efficacy of endovascular treatment as an alternative to chemical treatment. This study was designed to determine the efficacy of rapid endovascular treatment, in addition to standard care, for patients with acute ischemic stroke.

This prospective, randomized, open label, controlled trial included patients with ischemic stroke, enrolled within 10 hours of symptom onset. A contrast computed tomography (CT) and CT angiography were performed to identify participants with a small infarct core, an occluded proximal artery in the anterior circulation and moderate-to-good collateral circulation. Participants in both groups received intravenous alteplase within 4.5 hours after onset of stroke if they met accepted guidelines. Participants in the intervention group underwent rapid endovascular treatment, using available thrombectomy devices to achieve reperfusion. The primary outcome variable was the score on the modified Rankin scale at 90 days. Secondary and safety outcomes included early recanalization and reperfusion, intracranial hemorrhage, angiographic complications, neurologic disability at 90 days and death.

Analysis of the primary endpoint showed a common odds ratio of 2.6, favoring the intervention group (P<0.001). The median, 90-day modified Rankin scores were two in the intervention group and four in the control group (P<0.001). Mortality rates at 90 days were 10.4% in the intervention group and 19% in the control group (P=0.04). The rates of patients with a score on the Barthel index of 95 to 100 at three months were 57 7% in the intervention group and 33.6% in the control group.

This multicenter, randomized, controlled trial found that, among patients with acute ischemic stroke with a small infarct core, a proximal intracranial occlusion in the anterior circulation and moderate to good intracranial collateral circulation, rapid endovascular treatment can improve clinical outcome and reduce mortality.