Research in context
Evidence before this study
We searched PubMed with the terms “stroke + thrombectomy” for articles published in English before Dec 31, 2015. Our search returned numerous single-centre or multicentre studies or registry studies in which endovascular treatment improved recanalisation, and eight randomised clinical trials that investigated the effect of endovascular treatment on functional outcomes. The results of the three trials published in 2013 were negative, whereas those of the five trials published in 2015 showed that, in patients receiving standard care, complementary mechanical thrombectomy led to an increased proportion of patients achieving functional independence at 3 months with no increase in mortality.
Added value of this study
The THRACE trial also assessed functional outcomes after treatment with intravenous alteplase for thrombolysis plus mechanical thrombectomy versus intravenous thrombolysis alone in patients with acute cerebral ischaemia. To our knowledge, it is the largest study to show that mechanical thrombectomy is better than standard care alone. Although our results are consistent with those of other recent studies, the THRACE trial is unique because of its wide patient selection, with no imaging-based criteria beyond the requirement for large-vessel occlusion, and its rapid randomisation (<20 min after intravenous thrombolysis initiation), so that fast responders to intravenous alteplase were not excluded. Thus, results of the THRACE trial showed a benefit in functional outcome for the combined approach in a broad population of patients similar to that encountered in routine clinical practice.
Implications of all the available evidence
Mechanical thrombectomy seems to be beneficial and should be considered for a wide range of patients with large-vessel occlusions of the anterior circulation, regardless of age, sex, clinical severity, or intracranial location of the occlusion.