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Brain & Heart Advances in stroke treatment

Table 4. Main published trials from 2017 to 2023 on the endovascular therapy for acute ischemic stroke due to large vessel
occlusion and large ischemic cores, within 24 h from symptom onset
Trial name No. of Design Population Efficacy Safety outcomes Results
patients outcomes
randomized
ANGEL-ASPECT 456 Phase III, open-label, Anterior LVO, 6-24 h mRS at 90 days sICH, mortality Better functional
(2023) EVT+BMT versus from symptom onset outcomes in EVT
BMT compared to BMT alone
SELECT-2 (2023) 352 Phase III, open-label, Anterior LVO, 6-24 h mRS at 90 days sICH, procedural Improved functional
EVT+BMT versus from last known well complications outcomes in EVT for
BMT larger ischemic cores
TESLA (2023) 200 Phase III, open-label, Anterior LVO, mRS at 90 days sICH, procedural Better functional
EVT+BMT versus significant ischemic complications outcomes in EVT
BMT core, 6-24 h from compared to BMT alone
symptom onset
TENSION (2022) 208 Phase III, open-label, Anterior LVO, 4.5 – mRS at 90 days sICH, mortality Better functional
EVT+BMT versus 24 h from symptom outcomes in EVT
BMT onset, considering compared to BMT alone
non-contrast CT in the
stable ischemic core
RESCUE-Japan 203 Phase III, open-label, Anterior LVO, large mRS at 90 days sICH, Better functional
LIMIT (2022) EVT+BMT versus ischemic core defined procedural and outcomes in EVT
BMT by an ASPECTS score post-procedural compared to BMT alone
of 3 – 5 on CT or a complications
core volume ≥50 mL
on MRI, 6 – 24 h from
symptom onset
LASTE (2017) 102 Phase II, open-label, LVO, 6 – 24 h from mRS at 90 days sICH, procedural Potential benefit of EVT
EVT+BMT versus symptom onset complications but the limited sample size
BMT
Abbreviations: ANGEL-ASPECT: Endovascular therapy for anterior large vessel occlusion with significant ischemic core; ASPECTS: Alberta stroke
program early CT Score; BMT: Best medical treatment; CT: Computerized tomography; EVT: Endovascular therapy; LASTE: Late endovascular
therapy; LVO: Large vessel occlusion; MRI: Magnetic resonance imaging; mRS: Modified Rankin scale; RESCUE-Japan LIMIT: Recovery by
endovascular salvage for cerebral ultra-acute embolism–Japan large ischemic core trial; SELECT-2: Study of endovascular therapy in acute large
ischemic stroke; sICH: Symptomatic intracranial hemorrhage; TENSION: Endovascular therapy for ischemic stroke with extended window using
non-contrast imaging; TESLA: Thrombectomy for emergent salvage of large anterior circulation ischemic stroke.

primary thromboembolism or as distal migrations during This research suggests an expanding scope for EVT
EVT for proximal LVOs. Given the clinical variability and beyond LVOs, underscoring the need for additional studies
disability associated with DMVOs, further research is to confirm these preliminary findings and refine treatment
crucial to clarify EVT’s role in this context. protocols for both medium and distal vessel occlusions in

Studies by Marchal et al. suggest EVT promise for AIS management.
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DMVOs, especially in M2 segments, reporting 82.3% 2.6. Post-thrombectomy intra-arterial thrombolysis
successful recanalization with significant neurological
improvement and low sICH rates. Similarly, Rikhtegar Current guidelines lack definitive recommendations on
et al. achieved a 74.7% success rate using low-profile intra-arterial thrombolysis (IAT) post-MT for LVOs. The
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devices, though with higher sICH in older patients with CHOICE trial, investigated intra-arterial ALT post-
large infarcts. Ongoing trials, including ESCAPE-MeVO, thrombectomy to enhance microvascular reperfusion in
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DISTAL, ORIENTAL-MeVo, and DUSK, are pivotal AIS patients with LVOs. Conducted across seven Spanish
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in comparing EVT with medical therapy in DMVOs, stroke centers, CHOICE, included 121 patients with
evaluating disability at 90 days, quality of life, and cost- successful recanalization (TICI ≥ 2b) and randomized
effectiveness. Collectively, this research highlights EVT’s them to intra-arterial ALT (0.225 mg/kg) or placebo, with
expanding scope beyond LVOs, particularly for patients the primary endpoint being 90-day functional outcomes
who may benefit from improved microvascular reperfusion (mRS). Results showed that 59% of the ALT group achieved
post-thrombectomy (Table 5). favorable mRS scores (0 – 1), compared to 40.4% of the

Volume 3 Issue 3 (2025) 6 doi: 10.36922/bh.6683