Effect of Endovascular Treatment With vs Without IV Alteplase on Functional Independence After Acute Ischemic Stroke | Cerebrovascular Disease | JN Learning | AMA Ed Hub [Skip to Content]
Outline
Quiz
PDF
Cerebrovascular Infarction

Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic StrokeThe DEVT Randomized Clinical Trial

Educational Objective
To learn about the acute treatment of large vessel occlusion strokes.
1 Credit CME
JAMA
January 19, 2021
Original Investigation
Wenjie Zi, MD1;
Zhongming Qiu, MD1,2;
Fengli Li, MD1;
Hongfei Sang, MD1,3;
Deping Wu, MD1,4;
Weidong Luo, MD1;
Shuai Liu, MD1;
Junjie Yuan, MD1;
Jiaxing Song, MD1;
Zhonghua Shi, MD5;
Wenguo Huang, MD6;
Min Zhang, MS6;
Wenhua Liu, MD7;
Zhangbao Guo, MS7;
Tao Qiu, MD8;
Qiang Shi, MS8;
Peiyang Zhou, MD9;
Li Wang, MD10;
Xinmin Fu, MD11;
Shudong Liu, MD12;
Shiquan Yang, MD13;
Shuai Zhang, MD14;
Zhiming Zhou, MD15;
Xianjun Huang, MD15;
Yan Wang, MD16;
Jun Luo, MS17;
Yongjie Bai, MD18;
Min Zhang, MS19;
Youlin Wu, MS20;
Guoyong Zeng, MD21;
Yue Wan, MD22;
Changming Wen, MD23;
Hongbin Wen, MD24;
Wentong Ling, MS25;
Zhuo Chen, MS26;
Miao Peng, MS27;
Zhibing Ai, MD28;
Fuqiang Guo, MD29;
Huagang Li, MD30;
Jing Guo, MS31;
Haitao Guan, MD32;
Zhiyi Wang, MS33;
Yong Liu, MS34;
Jie Pu, MD35;
Zhen Wang, MD36;
Hansheng Liu, MD1;
Luming Chen, MD1;
Jiacheng Huang, MD1;
Guoqiang Yang, MD1;
Zili Gong, MD1;
Jie Shuai, MD1;
Raul G. Nogueira, MD37;
Qingwu Yang, MD, PhD1;
for the DEVT Trial Investigators
Author Affiliations
  • 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
  • 2Department of Neurology, The 903rd Hospital of The Chinese People’s Liberation Army, Xihu District, Hangzhou, China
  • 3Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
  • 4Huaian Medical District of Jingling Hospital, Medical School of Nanjing University, Huaian, China
  • 5Department of Neurosurgery, The 904th Hospital of The Chinese People’s Liberation Army, Wuxi, China
  • 6Department of Neurology, Maoming Traditional Chinese Medicine Hospital, Maonan District, Maoming, China
  • 7Department of Neurology, Wuhan No. 1 Hospital, Qiaokou District, Wuhan, China
  • 8Department of Neurology, The First People’s Hospital of Zigong, Da'an District, Zigong, China
  • 9Department of Neurology, The First People’s Hospital of Xiangyang, Fancheng District, Xiangyang, China
  • 10Department of Neurology, The Third People’s Hospital of Zigong, Gongjing District, Zigong, China
  • 11Department of Neurology, Xuzhou Central Hospital, Quanshan District, Xuzhou, China
  • 12Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan District, Chongqing, China
  • 13Department of Neurology, The 902nd Hospital of The Chinese People’s Liberation Army, Yuhui District, Bengbu, China
  • 14Department of Neurology, The Affiliated Hospital of Yangzhou University, Guangling District, Yangzhou, China
  • 15Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
  • 16Department of Neurology, The Fifth People’s Hospital of Chengdu, Wenjiang District, Chengdu, China
  • 17Department of Neurology, Sichuan Mianyang 404 Hospital, Fucheng District, Mianyang, China
  • 18Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Jianxi District, Luoyang, China
  • 19Department of Neurology, Jiangmen Central Hospital, Pengjiang District, Jiangmen, China
  • 20Department of Neurology, Chongzhou People's Hospital, Chongzhou, China
  • 21Department of Neurology, Ganzhou People's Hospital, Zhanggong District, Ganzhou, China
  • 22Department of Neurology, Yangluo District of Hubei Zhongshan Hospital, Qiaokou District, Wuhan, China
  • 23Department of Neurology, Nanyang Central Hospital, Wolong District, Nanyang, China
  • 24Department of Neurology, Xiangyang Central Hospital, Xiangcheng District, Xiangyang, China
  • 25Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
  • 26Department of Neurology, Mianzhu People's Hospital, Mianzhu, China
  • 27Department of Neurology, Deyang People’s Hospital, Jingyang District, Deyang, China
  • 28Department of Neurology, Taihe Affiliated Hospital of Shiyan, Shiyan, China
  • 29Department of Neurology, Sichuan Provincial People’s Hospital, Qingyang District, Chengdu, China
  • 30Department of Neurology, Zhongnan Hospital of Wuhan University, Wuchang District, Wuhan, China
  • 31Department of Neurology, Chongqing Three Gorges Central Hospital, Wanzhou District, Chongqing, China
  • 32Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Liwan District, Guangzhou, China
  • 33Department of Neurology, Huazhou People’s Hospital, Hexi District, Huazhou, China
  • 34Department of Neurology, Lu'an People’s Hospital, Jin'an District, Lu'an, China
  • 35Department of Neurology, Hubei Provincial People's Hospital, Wuchang District, Wuhan, China
  • 36Department of Neurology, Changsha Central Hospital, Yuhua District, Changsha, China
  • 37Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
  • DEVT Trial Investigatorsfor the
Read article on JAMA Network

MOC/CME Information

editorial comment icon
Editorial
Comment
 related articles icon
Related
Articles
 author interview icon
Interviews
 multimedia icon
Multimedia
  • Original Investigation
    Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis in Acute Ischemic Stroke
    Kentaro Suzuki, MD, PhD; Yuji Matsumaru, MD, PhD; Masataka Takeuchi, MD; Masafumi Morimoto, MD, PhD; Ryuzaburo Kanazawa, MD, PhD; Yohei Takayama, MD; Yuki Kamiya, MD, PhD; Keigo Shigeta, MD, PhD; Seiji Okubo, MD, PhD; Mikito Hayakawa, MD; Norihiro Ishii, MD, PhD; Yorio Koguchi, MD, PhD; Tomoji Takigawa, MD, PhD; Masato Inoue, MD, PhD; Hiromichi Naito, MD; Takahiro Ota, MD, PhD; Teruyuki Hirano, MD, PhD; Noriyuki Kato, MD, PhD; Toshihiro Ueda, MD, PhD; Yasuyuki Iguchi, MD, PhD; Kazunori Akaji, MD, PhD; Wataro Tsuruta, MD, PhD; Kazunori Miki, MD, PhD; Shigeru Fujimoto, MD, PhD; Tetsuhiro Higashida, MD, PhD; Mitsuhiro Iwasaki, MD; Junya Aoki, MD, PhD; Yasuhiro Nishiyama, MD, PhD; Toshiaki Otsuka, MD, PhD; Kazumi Kimura, MD, PhD; SKIP Study Investigators
Conversations with Dr Bauchner (21:48)
Thrombolysis Before Thrombectomy for Stroke
Video (23:51)
Thrombolysis Before Thrombectomy for Stroke
Read Article Take Quiz
Key Points

Question  Among patients with ischemic stroke secondary to large vessel occlusion and eligible for thrombolysis, is endovascular treatment alone noninferior to intravenous alteplase plus endovascular treatment with regard to functional independence?

Findings  In this randomized clinical trial that included 234 patients with acute ischemic stroke, the proportion who achieved functional independence at 90 days was 54.3% in the endovascular treatment alone group vs 46.6% in the intravenous alteplase plus endovascular treatment group, a difference that met the prespecified noninferiority margin of 10%.

Meaning  Among patients with acute ischemic stroke due to large vessel occlusion and eligible for thrombolysis, 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, although the clinical acceptability of the threshold for noninferiority should be considered when interpreting the results.

Abstract

Importance  For patients with large vessel occlusion strokes, it is unknown whether endovascular treatment alone compared with intravenous thrombolysis plus endovascular treatment (standard treatment) can achieve similar functional outcomes.

Objective  To investigate whether endovascular thrombectomy alone is noninferior to intravenous alteplase followed by endovascular thrombectomy for achieving functional independence at 90 days among patients with large vessel occlusion stroke.

Design, Setting, and Participants  Multicenter, randomized, noninferiority trial conducted at 33 stroke centers in China. Patients (n = 234) were 18 years or older with proximal anterior circulation intracranial occlusion strokes within 4.5 hours from symptoms onset and eligible for intravenous thrombolysis. Enrollment took place from May 20, 2018, to May 2, 2020. Patients were enrolled and followed up for 90 days (final follow-up was July 22, 2020).

Interventions  A total of 116 patients were randomized to the endovascular thrombectomy alone group and 118 patients to combined intravenous thrombolysis and endovascular thrombectomy group.

Main Outcomes and Measures  The primary end point was the proportion of patients achieving functional independence at 90 days (defined as score 0-2 on the modified Rankin Scale; range, 0 [no symptoms] to 6 [death]). The noninferiority margin was −10%. Safety outcomes included the incidence of symptomatic intracerebral hemorrhage within 48 hours and 90-day mortality.

Results  The trial was stopped early because of efficacy when 234 of a planned 970 patients had undergone randomization. All 234 patients who were randomized (mean age, 68 years; 102 women [43.6%]) completed the trial. At the 90-day follow-up, 63 patients (54.3%) in the endovascular thrombectomy alone group vs 55 (46.6%) in the combined treatment group achieved functional independence at the 90-day follow-up (difference, 7.7%, 1-sided 97.5% CI, −5.1% to ∞)P for noninferiority = .003). No significant between-group differences were detected in symptomatic intracerebral hemorrhage (6.1% vs 6.8%; difference, −0.8%; 95% CI, −7.1% to 5.6%) and 90-day mortality (17.2% vs 17.8%; difference, −0.5%; 95% CI, −10.3% to 9.2%).

Conclusions and Relevance  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.

Trial Registration  Chinese Clinical Trial Registry: ChiCTR-IOR-17013568

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Related Articles

  1. Intravenous Thrombolysis Before Endovascular Thrombectomy for Acute Ischemic Stroke

  2. Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis in Acute Ischemic Stroke
    1.00 CME

Related Multimedia

  1. Thrombolysis Before Thrombectomy for Stroke
    0.50 CME

  2. Thrombolysis Before Thrombectomy for Stroke

View All Featured

See More About

Cerebrovascular Disease Emergency Medicine Neurology Stroke Cerebrovascular Hemorrhage Cerebrovascular Infarction Radiology
Article Information

Corresponding Authors: Qingwu Yang, MD, PhD, Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), No. 183 Xinqiao Main St, Shapingba District, Chongqing 400037, China (yangqwmlys@163.com); Raul G. Nogueira, MD, Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, 80 Jesse Hill Jr Dr SE, Room 8D108A, Atlanta, GA 30303 (raul.g.nogueira@emory.edu).

Accepted for Publication: December 3, 2020.

Author Contributions: Drs Q. Yang and Nogueira had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Zi and Z. Qiu are co–first authors. Drs Q. Yang and Nogueira are co–corresponding authors.

Concept and design: Zi, Z. Qiu, F. Li, Sang, D. Wu, W. Liu, Shuai, Nogueira, Q. Yang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Zi, Z. Qiu, F. Li, Sang, D. Wu, W. Luo, W. Liu, Z. Zhou, Bai, Q. Yang.

Statistical analysis: W. Luo, Shuai Liu, X. Huang.

 Obtained funding: Zi, Z. Qiu, F. Li, Sang, Q. Yang.

Administrative, technical, or material support: Zi, Z. Qiu, F. Li, Sang, D. Wu, W. Luo, Shuai Liu, Yuan, Song, Z. Shi, W. Huang, Min Zhang, W. Liu, Z. Guo, T. Qiu, Q. Shi, P. Zhou, L. Wang, Fu, Shudong Liu, S. Yang, S. Zhang, Z. Zhou, X. Huang, Y. Wang, J. Luo, Bai, Min Zhang, Y. Wu, Zeng, Wan, C. Wen, H. Wen, Ling, Z. Chen, Peng, Ai, F. Guo, H. Li, J. Guo, Guan, Zhiyi Wang, Y. Liu, Pu, Zhen Wang, H. Liu, L. Chen, J. Huang, G. Yang, Gong, Shuai, Q. Yang.

Supervision: Zi, Z. Qiu, F. Li, Sang, D. Wu, Shuai, Nogueira, Q. Yang.

Conflict of Interest Disclosures: Dr Nogueira reported receiving consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, and Stryker Neurovascular and having stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze. No other disclosures were reported.

Funding/Support: The study was supported by grants 81525008, 81901236, 81801157 from the National Natural Science Foundation of China, 2019ZX001 from the Chongqing Major Disease Prevention and Control Technology Research Project, 2019XLC2008 2019XLC3016 from the Clinical Medical Research Talent Training Program of Army Medical University, and 2018JSLC0017 from the Major Clinical Innovation Technology Project of the Second Affiliated Hospital of Army Medical University.

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The DEVT Trial members are listed in Supplement 1.

Data Sharing Statement: See Supplement 5.

References
1.
Bracard  S , Ducrocq  X , Mas  JL ,  et al; THRACE investigators.  Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial.   Lancet Neurol. 2016;15(11):1138-1147. doi:10.1016/S1474-4422(16)30177-6 PubMedGoogle ScholarCrossref
2.
Saver  JL , Goyal  M , Bonafe  A ,  et al; SWIFT PRIME Investigators.  Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke.   N Engl J Med. 2015;372(24):2285-2295. doi:10.1056/NEJMoa1415061 PubMedGoogle ScholarCrossref
3.
Jovin  TG , Chamorro  A , Cobo  E ,  et al; REVASCAT Trial Investigators.  Thrombectomy within 8 hours after symptom onset in ischemic stroke.   N Engl J Med. 2015;372(24):2296-2306. doi:10.1056/NEJMoa1503780 PubMedGoogle ScholarCrossref
4.
Goyal  M , Demchuk  AM , Menon  BK ,  et al; ESCAPE Trial Investigators.  Randomized assessment of rapid endovascular treatment of ischemic stroke.   N Engl J Med. 2015;372(11):1019-1030. doi:10.1056/NEJMoa1414905 PubMedGoogle ScholarCrossref
5.
Campbell  BC , Mitchell  PJ , Kleinig  TJ ,  et al; EXTEND-IA Investigators.  Endovascular therapy for ischemic stroke with perfusion-imaging selection.   N Engl J Med. 2015;372(11):1009-1018. doi:10.1056/NEJMoa1414792 PubMedGoogle ScholarCrossref
6.
Berkhemer  OA , Fransen  PS , Beumer  D ,  et al; MR CLEAN Investigators.  A randomized trial of intraarterial treatment for acute ischemic stroke.   N Engl J Med. 2015;372(1):11-20. doi:10.1056/NEJMoa1411587 PubMedGoogle ScholarCrossref
7.
Martins  SO , Mont’Alverne  F , Rebello  LC ,  et al; RESILIENT Investigators.  Thrombectomy for stroke in the public health care system of Brazil.   N Engl J Med. 2020;382(24):2316-2326. doi:10.1056/NEJMoa2000120 PubMedGoogle ScholarCrossref
8.
Behme  D , Kabbasch  C , Kowoll  A ,  et al.  Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions.   J Stroke Cerebrovasc Dis. 2016;25(4):954-959. doi:10.1016/j.jstrokecerebrovasdis.2016.01.007PubMedGoogle ScholarCrossref
9.
Desilles  J-P , Loyau  S , Syvannarath  V ,  et al.  Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke.   Stroke. 2015;46(11):3241-3248. doi:10.1161/STROKEAHA.115.010721PubMedGoogle ScholarCrossref
10.
Ren  Y , Churilov  L , Mitchell  P , Dowling  R , Bush  S , Yan  B .  Clot migration is associated with intravenous thrombolysis in the setting of acute ischemic stroke.   Stroke. 2018;49(12):3060-3062. doi:10.1161/STROKEAHA.118.022751 PubMedGoogle ScholarCrossref
11.
Yaghi  S , Eisenberger  A , Willey  JZ .  Symptomatic intracerebral hemorrhage in acute ischemic stroke after thrombolysis with intravenous recombinant tissue plasminogen activator: a review of natural history and treatment.   JAMA Neurol. 2014;71(9):1181-1185. doi:10.1001/jamaneurol.2014.1210PubMedGoogle ScholarCrossref
12.
Rai  AT , Boo  S , Buseman  C ,  et al.  Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes.   J Neurointerv Surg. 2018;10(1):17-21. doi:10.1136/neurintsurg-2016-012830PubMedGoogle ScholarCrossref
13.
Yang  P , Zhang  Y , Zhang  L ,  et al; DIRECT-MT Investigators.  Endovascular thrombectomy with or without intravenous alteplase in acute stroke.   N Engl J Med. 2020;382(21):1981-1993. doi:10.1056/NEJMoa2001123 PubMedGoogle ScholarCrossref
14.
Suzuki  K , Kimura  K , Takeuchi  M ,  et al. Randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion—a prospective multicenter randomized trial. American Heart Association Professional Heart Daily. Accessed December 1, 2020. https://professional.heart.org/en/science-news/skip-study-clinical-trial-details
15.
Qiu  Z , Liu  H , Li  F ,  et al; DEVT study investigators.  DEVT: A randomized, controlled, multicenter trial of direct endovascular treatment versus standard bridging therapy for acute stroke patients with large vessel occlusion in the anterior circulation—protocol.   Int J Stroke. 2020;1747493020925349. doi:10.1177/1747493020925349 PubMedGoogle Scholar
16.
Zaidat  OO , Yoo  AJ , Khatri  P ,  et al; Cerebral Angiographic Revascularization Grading (CARG) Collaborators; STIR Revascularization working group; STIR Thrombolysis in Cerebral Infarction (TICI) Task Force.  Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement.   Stroke. 2013;44(9):2650-2663. doi:10.1161/STROKEAHA.113.001972 PubMedGoogle ScholarCrossref
17.
von Kummer  R , Broderick  JP , Campbell  BC ,  et al.  The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy.   Stroke. 2015;46(10):2981-2986. doi:10.1161/STROKEAHA.115.010049 PubMedGoogle ScholarCrossref
18.
Wang  H , Zi  W , Hao  Y ,  et al; ACTUAL Investigators.  Direct endovascular treatment: an alternative for bridging therapy in anterior circulation large-vessel occlusion stroke.   Eur J Neurol. 2017;24(7):935-943. doi:10.1111/ene.13311 PubMedGoogle ScholarCrossref
19.
Broeg-Morvay  A , Mordasini  P , Bernasconi  C ,  et al.  Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis.   Stroke. 2016;47(4):1037-1044. doi:10.1161/STROKEAHA.115.011134 PubMedGoogle ScholarCrossref
20.
Bellwald  S , Weber  R , Dobrocky  T ,  et al.  Direct mechanical intervention versus bridging therapy in stroke patients eligible for intravenous thrombolysis: a pooled analysis of 2 registries.   Stroke. 2017;48(12):3282-3288. doi:10.1161/STROKEAHA.117.018459 PubMedGoogle ScholarCrossref
21.
Mehta  CR , Pocock  SJ .  Adaptive increase in sample size when interim results are promising: a practical guide with examples.   Stat Med. 2011;30(28):3267-3284. doi:10.1002/sim.4102 PubMedGoogle ScholarCrossref
22.
Yoon  W , Seo  JJ , Kim  JK , Cho  KH , Park  JG , Kang  HK .  Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke.   Stroke. 2004;35(4):876-881. doi:10.1161/01.STR.0000120726.69501.74 PubMedGoogle ScholarCrossref
23.
Goyal  M , Menon  BK , van Zwam  WH ,  et al; HERMES collaborators.  Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.   Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X PubMedGoogle ScholarCrossref
24.
Román  LS , Menon  BK , Blasco  J ,  et al; HERMES collaborators.  Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data.   Lancet Neurol. 2018;17(10):895-904. doi:10.1016/S1474-4422(18)30242-4 PubMedGoogle ScholarCrossref
25.
Seners  P , Turc  G , Maïer  B , Mas  J-L , Oppenheim  C , Baron  J-C .  Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis.   Stroke. 2016;47(9):2409-2412. doi:10.1161/STROKEAHA.116.014181 PubMedGoogle ScholarCrossref
26.
Jiang  F , Zhao  W , Wu  C ,  et al.  Asymptomatic intracerebral hemorrhage may worsen clinical outcomes in acute ischemic stroke patients undergoing thrombectomy.   J Stroke Cerebrovasc Dis. 2019;28(6):1752-1758. doi:10.1016/j.jstrokecerebrovasdis.2019.02.006 PubMedGoogle ScholarCrossref
27.
Constant Dit Beaufils  P , Preterre  C , De Gaalon  S ,  et al; Endovascular Treatment in Ischemic Stroke (ETIS) Research Investigators.  Prognosis and risk factors associated with asymptomatic intracranial hemorrhage after endovascular treatment of large vessel occlusion stroke: a prospective multicenter cohort study.   Eur J Neurol. 2020;0(0):1-9. doi:10.1111/ene.14539 PubMedGoogle Scholar
28.
Hill  MD , Goyal  M , Menon  BK ,  et al; ESCAPE-NA1 Investigators.  Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial.   Lancet. 2020;395(10227):878-887. doi:10.1016/S0140-6736(20)30258-0 PubMedGoogle ScholarCrossref
29.
Gu  H-Q , Rao  Z-Z , Yang  X ,  et al; Chinese Stroke Center Alliance Investigators.  Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke.   Stroke. 2019;50(4):1013-1016. doi:10.1161/STROKEAHA.118.024232 PubMedGoogle ScholarCrossref
30.
Campbell  BCV , Mitchell  PJ , Churilov  L ,  et al; EXTEND-IA TNK Investigators.  Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke.   N Engl J Med. 2018;378(17):1573-1582. doi:10.1056/NEJMoa1716405 PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Privacy Policy|Terms of Use
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue