What question needs to be answered before a trial starts, that compares iv versus endovascular therapy for acute ischemic stroke?
After the SYNTHESIS and IMS-3 trials, what population should this be attempted in? Certainly not all comers. In addition, newer devices seem to lead to faster recanalization, therefore can newer devices, used in appropriately selected early patients, improve outcomes versus legitimate maximal medical management (without crossover's) in a randomized trial.
Hi Christian, I think that the main issues when designing a trial like that are:
- Whether it will study primary or also rescue therapy.
- whether there will be any kind of advanced imaging selection.
- whether endovascular therapy will be done fast enough.
Here in Barcelona we are doing the REVASCAT trial and we addressed all these issues before, have a look if you are interested:
http://clinicaltrials.gov/show/NCT01692379
I think the use of the new devices over the old ones, since the are increased reperfusion rates with endovascular procedures but for instance, the IMS-III didn't have many new devices before the trial was stopped i.e. the new stent retriever technology.
Does combining neuroprotection with revascularization improve outcomes? I think this is one of the hot topics right now.
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