Investigators are conducting a real world, observational, prospective, multicenter study to better understand treatment for patients with MeVo and distal vessel occlusions in the U.S post publication of recent MeVO trials.
Inclusion
Acute ischemic stroke clinically eligible for immediate EVT
Age ≥18 - 85 years of age
Time from onset (or last-seen-well) to 24 hours
Disabling stroke defined as follows:
A. Baseline National Institutes of Health Stroke Scale (NIHSS) score >5 B. Baseline NIHSS 3-5 with disabling deficit (e.g., hemianopia, aphasia, loss of hand function) as determined and agreed upon by two physicians in context of the patient's life
Confirmed treatable MeVO based on neurovascular non-invasive imaging (CTA or MRA), at one or more of the following locations: M2 or M3 segment, A2 or A3 segment, P1, P2 or P3 segment
Informed consent: Within the first 72 hours after inclusion in the study
ASPECTS ≥5
mRS≤2
Exclusion Criteria:
Age >86
ASPECTS ≤ 5
Any intracranial hemorrhage on initial CT head non contrast
mRS≥3
Known pregnancy (local protocol to determine if patient is pregnant at the time of stroke)
Known severe allergy (more than a rash) to contrast media uncontrolled by medications
CT evidence of the following conditions:
Acute bilateral strokes
Contraindication to antiplatelet (aspirin, clopidogrel, ticagrelor, cangrelor) or contrast agents
Intracranial tumors other than small meningioma that does not require surgery for one year post randomization.
Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of >3.0 or Partial Thromboplastin Time (PTT) >3 times of normal
Baseline platelet count <80,000 per microliter (µl)
Life expectancy is less than one year prior to stroke onset14. Participation in another randomized clinical trial that could confound the evaluation of the study outcomes
15. Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed
klimaye@iu.edu
Intra-arterial Treatment
Intravenous Thrombolytic
EndovaSCular TreAtment to imProve outcomEs for Medium Vessel Occlusions (ESCAPE-MeVO Trial)
Intra-arterial Thrombolysis for Acute Ischemic Stroke With Medium Vessel Occlusion
Evaluation of Endovascular Treatment in Acute Intracranial Distal Medium Vessel Occlusion Stroke
COMPLETE: International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device
OPtimizing REperfusion by Intra-Arterial ThRomboLysis as Adjunct to Endovascular Treatment for Medium Vessel Occlusion
PROMISE: PRedictors Of Good outcoMes in Thrombectomy for Large Infarct Core Stroke Evaluation