title: Stroke treatment academic industry roundtable: research priorities in the assessment of neurothrombectomy devices.
abstract: OBJECTIVE
  The goal of the Stroke Treatment Academic Industry Roundtable (STAIR) meetings is to advance the development of stroke therapies. At STAIR VIII, consensus recommendations were developed for clinical trial strategies to demonstrate the benefit of endovascular reperfusion therapies for acute ischemic stroke.
  
  
  RESULTS
  Prospects for success with forthcoming endovascular trials are robust, because new neurothrombectomy devices have superior reperfusion efficacy compared with earlier-generation interventions. Specific recommendations are provided for trial designs in 3 populations: (1) patients undergoing intravenous fibrinolysis, (2) early patients ineligible for or having failed intravenous fibrinolysis, and (3) wake-up and other late-presenting patients. Among intravenous fibrinolysis-eligible patients, key principles are that CT or MRI confirmation of target arterial occlusions should precede randomization; endovascular intervention should be pursued with the greatest rapidity possible; and combined intravenous and neurothrombectomy therapy is more promising than neurothrombectomy alone. Among patients ineligible for or having failed intravenous fibrinolysis, scientific equipoise was affirmed and the need to randomize all eligible patients emphasized. Vessel imaging to confirm occlusion is mandatory, and infarct core and penumbral imaging is desirable in later time windows. Additional STAIR VIII recommendations include approaches to test multiple devices in a single trial, utility weighting of disability end points, and adaptive designs to delineate time and tissue injury thresholds at which benefits from intervention no longer accrue.
  
  
  CONCLUSIONS
  Endovascular research priorities in acute ischemic stroke are to perform trials testing new, highly effective neuro thrombectomy devices rapidly deployed in patients confirmed to have target vessel occlusions.
authors.affiliation: From the Stroke Center and Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (J.L.S.); Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, PA (T.G.J.); Department of Neurology, University of California, San Francisco (W.S.S.); and Stroke Center and Department of Neurology, Stanford University School of Medicine, CA (G.W.A.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.forename: Johannes
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authors.lastname: Boltze
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Davis
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Salvatore
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authors.lastname: DeSena
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.forename: Werner
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authors.lastname: Hacke
authors.forename: Bill
authors.initials: B
authors.lastname: Holt
authors.forename: Reza
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authors.lastname: Jahan
authors.forename: Hui
authors.initials: H
authors.lastname: Jing
authors.forename: Pooja
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authors.lastname: Khatri
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Marie
authors.initials: M
authors.lastname: Luby
authors.forename: Patrick
authors.initials: P
authors.lastname: Lyden
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Megerian
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.forename: Keith W
authors.initials: KW
authors.lastname: Muir
authors.forename: Howard A
authors.initials: HA
authors.lastname: Rowley
authors.forename: Richard M
authors.initials: RM
authors.lastname: Ruedy
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
authors.forename: Vitas J
authors.initials: VJ
authors.lastname: Sipelis
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Shimp
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.forename: Ona
authors.initials: O
authors.lastname: Wu
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery*; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D012107:Research Design; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents
keywords: endovascular recanalization; ischemic; reperfusion; stroke