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Current guidelines recommend intravenous thrombolysis (IVT) for select patients with acute ischemic stroke, and they also recommend that patients with large-vessel occlusion in the anterior circulation be considered for endovascular thrombectomy (EVT). In patients who can be treated with IVT within 4.5 hours, some clinicians have wondered whether EVT alone would be faster and achieve better results. Two new trials address this question.
In the multicenter trial SWIFT-DIRECT (Fischer et al.), partially funded by the thrombectomy device manufacturer, the study team randomly assigned 408 patients (mean age 73 years; 51% women) to a policy of IVT+EVT or EVT alone. The primary study outcome was functional independence at 90 days, judged by a modi…