Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial
RCT in 234 patients with acute ischaemic stroke found endovascular treatment (EVT) alone was noninferior to i/v alteplase plus EVT (functional independence at 90 days was achieved in 54.3% vs 46.6% respectively, a difference that met the prespecified noninferiority margin of 10%)
Source:
Journal of the American Medical Association
SPS commentary:
An associated editorial discusses the results of this study and another related study which investigated whether mechanical thrombectomy alone is non-inferior to combined intravenous thrombolysis (using 0.6-mg/kg alteplase) plus mechanical thrombectomy regarding functional outcomes. The authors of the editorial state that these studies contribute to the mounting evidence that endovascular treatment (EVT) alone achieves outcomes that may be non-inferior to outcomes achieved with combined i/v thrombolysis (IVT) plus EVT for patients with acute ischaemic stroke due to large vessel occlusions (AIS-LVO). They summarise the data from the two trials and refer to a previous study which resulted in similar findings. The authors of the editorial add that given the generally congruent results of the completed trials, clinicians must now consider whether and how to apply these findings thoughtfully in routine clinical practice. However, several caveats are highlighted for consideration whenever the strategy of not providing the proven therapy of IVT is being considered.