Methodology: 5/5
Usefulness: 4/5
Goyal M, et al. N Engl J Med. 2025 Feb 5. doi: 10.1056/NEJMoa2411668.
Question and Methods: This multi-center, open label RCT of 530 patients presenting with medium-sized vessel stroke within 12h of last seen well compared functional outcomes at 90-days between EVT with standard medical care and standard medical care alone.
Findings: There was no significant difference in functional outcomes at 90-days (using the modified Rankin scale score) between EVT with standard medical care (41.6%) and standard medical care alone (43.1%), with a risk ratio of 0.97 (0.79-1.18).
Limitations: Limitations include a lack of blinding of patients and clinicians, technical EVT success could not be achieved in about ¼ of the cases, the median time from onset to EVT was higher in this study (359 min vs 241 minutes), and 15% of patients in the EVT group had recanalization from thrombolysis only.
Interpretation: Patients presenting with medium-sized vessel stroke within 12h of last seen well should not proceed with EVT. However, they should still receive standard medical care with thrombolysis if presenting within the right time frame.
Dr. Sandrine Pageau
JC Supervisor: Dr. Krishan Yadav
