REBEL EM - March 18, 2021 - By Anand Swaminathan
“Clinical Question: Is endovascular mechanical thrombectomy alone non-inferior to endovascular therapy + systemic thrombolytics in the treatment of patients with large vessel occlusion (LVO) strokes presenting within 4.5 hours of onset?
- The DEVT Trial
- Authors Conclusions: “Among patients with ischemic stroke due to proximal anterior circulation occlusion within 4.5 hours from onset, endovascular treatment alone, compared with intravenous alteplase plus endovascular treatment, met the prespecified statistical threshold for noninferiority for the outcome of 90-day functional independence. These findings should be interpreted in the context of the clinical acceptability of the selected noninferiority threshold.”
- Our Conclusions: Endovascular therapy alone met the non-inferiority threshold when compared to combination therapy. However, this was a small trial that was stopped early and should be taken in context with all the available literature on the subject.
- The SKIP Trial
- Authors Conclusions: “Among patients with acute large vessel occlusion stroke, mechanical thrombectomy alone, compared with combined intravenous thrombolysis plus mechanical thrombectomy, failed to demonstrate noninferiority regarding favorable functional outcome. However, the wide confidence intervals around the effect estimate also did not allow a conclusion of inferiority.”
- Our Conclusions: The authors did not demonstrate non-inferiority for thrombectomy alone in comparison to combination treatment.”