title: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.
abstract: BACKGROUND
  Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome.
  
  
  METHODS
  We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group). Patients had confirmed occlusions in the proximal anterior intracranial circulation and an absence of large ischemic-core lesions. The primary outcome was the severity of global disability at 90 days, as assessed by means of the modified Rankin scale (with scores ranging from 0 [no symptoms] to 6 [death]).
  
  
  RESULTS
  The study was stopped early because of efficacy. At 39 centers, 196 patients underwent randomization (98 patients in each group). In the intervention group, the median time from qualifying imaging to groin puncture was 57 minutes, and the rate of substantial reperfusion at the end of the procedure was 88%. Thrombectomy with the stent retriever plus intravenous t-PA reduced disability at 90 days over the entire range of scores on the modified Rankin scale (P<0.001). The rate of functional independence (modified Rankin scale score, 0 to 2) was higher in the intervention group than in the control group (60% vs. 35%, P<0.001). There were no significant between-group differences in 90-day mortality (9% vs. 12%, P=0.50) or symptomatic intracranial hemorrhage (0% vs. 3%, P=0.12).
  
  
  CONCLUSIONS
  In patients receiving intravenous t-PA for acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, thrombectomy with a stent retriever within 6 hours after onset improved functional outcomes at 90 days. (Funded by Covidien; SWIFT PRIME ClinicalTrials.gov number, NCT01657461.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafe
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Vitor M
authors.initials: VM
authors.lastname: Pereira
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
authors.forename: Christophe
authors.initials: C
authors.lastname: Cognard
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Olav
authors.initials: O
authors.lastname: Jansen
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.forename: Blaise W
authors.initials: BW
authors.lastname: Baxter
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Devlin
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Reddy
authors.forename: Richard
authors.initials: R
authors.lastname: du Mesnil de Rochemont
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000628:therapy; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator