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IV thrombolysis (IVT) has been the standard-of-care treatment for eligible patients with acute ischemic stroke (AIS) since publication of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trial in 1995. When endovascular thrombectomy (EVT) was shown to be beneficial for treatment of AIS secondary to large vessel occlusion (LVO), this raised the question of whether patients heading toward EVT should continue to be treated with IVT first. As IVT was the standard of care at the time that the pivotal trials showing benefit of EVT were performed, most of the patients included in those studies received IVT before EVT. Over the past 2 years, 4 randomized clinical trials have evaluated the relative efficacy and safety of EVT alone vs IVT before EVT in patients who present to a center capable of providing EVT. Two of these trials met their prespecified threshold for noninferiority of EVT compared with combined IVT and EVT1,2 and 2 trials did not meet their noninferiority thresholds.3,4
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 648
- Received November 29, 2022.
- Accepted in final form December 6, 2022.
- © 2022 American Academy of Neurology
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