Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial
Trial in patients (n=204) with acute large vessel occlusion stroke failed to demonstrate non-inferiority (NI) of mechanical thrombectomy (MT) alone vs. combined i/v thrombolysis plus MT for favourable functional outcome (OR 1.09 [95% confidence limit below the NI margin of 0.74])
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 endovascular treatment alone is non-inferior to intravenous alteplase plus endovascular treatment with regard to functional independence in people with ischaemic stroke secondary to large vessel occlusion. 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 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.