🏥 Individual Trial Details (Complete PICO)
1. RESCUE-JAPAN LIMIT (2022)
Multicenter, Open-label, RCT, PROBE | n=203 (101 EVT, 102 Control)
Yoshimura S, et al. NEJM 2022 | doi:10.1056/NEJMoa2118191
PPopulation: LVO (ICA/M1), ASPECTS 3-5 on NCCT or DWI, NIHSS ≥6, pre-stroke mRS 0-1, onset ≤6h (or ≤24h if FLAIR neg)
IIntervention: EVT (stent retriever/aspiration/balloon) + IV alteplase 0.6 mg/kg
CControl: Medical management alone (± IV alteplase)
OOutcome:
| Outcome | EVT (n=101) | Control (n=102) | Effect | P-value | NNT |
|---|
| mRS 0-3 (Primary) | 36% | 26% | — | P=0.02 | 10 |
| mRS 0-2 at 90d | 9.5% | 0% | — | — | — |
| mRS shift (Secondary) | — | — | OR 1.42 (0.88-2.29) | P=0.15 (NS) | — |
| Symptomatic ICH | 9% | 5% | — | P=0.24 | — |
2. ANGEL-ASPECT (2023)
Multicenter, Prospective, Open-label, RCT | n=456 (230 EVT, 226 Control)
Li Q, et al. NEJM 2023 | doi:10.1056/NEJMoa2213379
PPopulation: LVO (ICA/M1), ASPECTS 3-5 or core 70-100 mL on CTP/DWI, onset ≤24h
IIntervention: EVT + medical management (IV alteplase if indicated)
CControl: Medical management alone
OOutcome:
| Outcome | EVT (n=230) | Control (n=226) | Effect | P-value | NNT |
|---|
| mRS shift (Primary) | — | — | OR 1.37 (1.11-1.69) | P=0.004 | 8 |
| mRS 0-3 at 90d | 20% | 12% | — | P=0.02 | 12.5 |
| Reperfusion at 24h (TICI ≥2b) | 52% | 27% | — | — | — |
| Symptomatic ICH | 6.1% | 2.7% | — | P=0.07 | — |
| 90-day mortality | 22% | 21% | — | NS | — |
3. SELECT2 (2023)
International, Multicenter, Prospective, Open-label, Adaptive RCT | n=352 (stopped early)
Sarraj A, et al. NEJM 2023 | doi:10.1056/NEJMoa2214403
PPopulation: LVO (ICA/M1), ASPECTS ≤5 or core ≥50 mL on CTP/DWI, onset ≤24h, age 18-85
IIntervention: EVT + medical care (stent retrievers, aspiration)
CControl: Medical care alone
OOutcome:
| Outcome | EVT (n=178) | Control (n=174) | Effect | P-value | NNT |
|---|
| mRS shift (Primary) | — | — | OR 1.51 (1.20-1.89) | P<0.001 | 4.7 |
| mRS 0-3 at 90d | 30% | 15% | RR 2.06 | — | 6.7 |
| mRS 0-2 at 90d | 18% | 7% | RR 2.97 | — | 9 |
| Symptomatic ICH | 1% | 2% | — | — | — |
4. TENSION (2023)
Multicenter, Open-label, RCT | n=253
Bendszus M, et al. Lancet Neurol. 2023
PPopulation: LVO (ICA/M1), ASPECTS ≤5 or core ≥70 mL, onset 6-24h, age ≥18
IIntervention: EVT + medical therapy
CControl: Medical therapy alone
OOutcome:
| Outcome | EVT | Control | Effect | P-value |
|---|
| mRS shift (Primary) | — | — | OR 1.53 (1.14-2.04) | P=0.004 |
| mRS 0-2 at 90d | 29% | 17% | — | — |
| Symptomatic ICH | Similar | Similar | — | NS |
5. TESLA (2024) ⚠️ NEGATIVE TRIAL
Multicenter, Open-label, Blinded-endpoint, Bayesian-adaptive RCT | n=300 (152 EVT, 148 Control)
Costalat V, et al. JAMA 2024
PPopulation: LVO (ICA/M1), ASPECTS 2-5 on NONCONTRAST CT ONLY (no perfusion), onset ≤24h
IIntervention: EVT + usual care
CControl: Usual care alone
OOutcome:
| Outcome | EVT (n=152) | Control (n=148) | Effect | P-value | Result |
|---|
| UW-mRS (Primary) | 2.93 | 2.27 | Diff 0.63 (95% CrI -0.09 to 1.34) | Post. prob 0.96 | NOT SIGNIFICANT |
| 90-day mortality | 35.3% | 33.3% | — | NS | — |
| Symptomatic ICH | 4.0% | 1.3% | — | — | — |
⚠️ 95% CrI included both no effect AND clinically relevant benefit. NCCT-only selection may be insufficient.
6. LASTE (2024)
Multicenter, Randomized, Open-label, Adjudicator-blinded | n=324 (159 EVT, 165 Control)
Moret C, et al. NEJM 2024 | doi:10.1056/NEJMoa2314063
PPopulation: LVO (ICA/M1), ASPECTS ≤5 (median 2), NIHSS ≥6 (median 21), pre-stroke mRS ≤1, onset ≤6.5h (or ≤24h if FLAIR neg)
IIntervention: EVT + medical therapy (median onset-to-thrombectomy: 305 min)
CControl: Medical therapy alone
OOutcome:
| Outcome | EVT (n=159) | Control (n=165) | Effect | P-value | NNT |
|---|
| mRS median (Primary) | 4 | 6 | OR 1.63 (1.29-2.06) | P<0.001 | ~7 |
| All-cause death (90d) | 36.1% | 55.5% | RR 0.65 (0.50-0.84) | P<0.001 | 5 |
| Symptomatic ICH | 9.6% | 5.7% | RR 1.73 (0.78-4.68) | NS | — |
✅ First trial to show significant mortality reduction (NNT=5 for survival)