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| Study | Subjects | Centers | Trial arms | Types of treatment | Flaws | Conclusions |
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| IMS III | 656 | 58 | (1) IV rtPA; (2) IV rtPA + endovascular | tPA (0.9 mg per kilogram)
Merci retriever, Penumbra system, and Solitaire FR stent retriever | (1) Only 47% of enrolled patients had CT angiogram imaging at the time of enrollment
(2) 20% of patients assigned to the IA treatment arm had no LVO or had thrombus that was inaccessible by catheter therapies
(3) Significant majority in IA arm received less than the standard dose of IV rtPA before undergoing angiography
(4) Utilization of first-generation thrombectomy devices | Comparable safety outcomes and no significant difference in functional independence with endovascular therapy after intravenous tPA, as compared with intravenous tPA alone |
|
| MR RESCUE | 127 | 22 | (1) Good penumbral pattern + thrombectomy
(2) No penumbral pattern + thrombectomy
(3) Good penumbral pattern + medical therapy
(4) No penumbral pattern + medical therapy | Merci retriever, Penumbra system | (1) Only included first-generation endovascular thrombectomy technologies
(2) The small number of patients assigned to each of the 4 groups has likely underpowered this trial
(3) Only 16 of 64 patients (27%) achieved TICI 2b or 3 reperfusion | (1) A favorable penumbral pattern on neuroimaging did not identify patients who would differentially benefit from endovascular therapy
(2) Embolectomy has not shown to be superior to standard care, in terms of safety and functional outcomes |
|
| SYNTHESIS Expansion | 362 | | (1) IV rtPA
(2) Endovascular | Wire manipulation, IA rtPA, Merci retriever, Penumbra system, and Solitaire stent retrievers | (1) No preprocedural imaging was obtained to confirm LVO
(2) No defined lower threshold of NIHSS; 10% of patients in the SYNTHESIS trial randomly assigned to intervention did not harbor an LVO at angiography
(3) Treatment was initiated approximately 1 hour later in the IA arm compared with the IV arm
(4) Failing to report the revascularization (TICI) | No difference in functional outcome, safety, or mortality between the trial arms |
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| SWIFT | 144 | 18 | (1) Solitaire (stent-retriever thrombectomy)
(2) Merci (mechanical thrombectomy) | Solitaire stent retriever, Merci retriever | — | The Solitaire Flow Restoration Device achieved substantially better angiographic, safety, and clinical outcomes than did the Merci Retrieval System |
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| Trevo 2 | 178 | 27 | (1) Trevo (stent-retriever thrombectomy)
(2) Merci (mechanical thrombectomy) | Trevo stent retriever, Merci retriever | | Trevo retrievers achieved substantially better angiographic and clinical outcomes than did the Merci Retrieval System; safety endpoint did not differ between the trial arms |
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